Palliative Care for the Management of Patients with Allogeneic Hematopoietic Stem Cell Transplantation: A Cross-Sectional Survey in Comprehensive Cancer Centers

Specialist palliative care (SPC) is rarely integrated into the management of patients with an allogeneic hematopoietic stem-cell transplantation, despite considerable symptom burden and mortality. We aimed to assess hematologists' and nurses' views on SPC integration. Multi-center cross-sectional survey with exploratory character. We asked when to best integrate SPC, with three vignettes of patients with good (90% chance of cure/10% risk of death), 'fifty-fifty', or poor (10%/90%) prognosis, and assessed preferences regarding integration models and support. We calculated descriptive statistics, and associations with Chi2/Fisher's exact tests and non-parametric tests. There were 80 respondents (56% females; mean age: 36.2 years, SD = 7.7; 47 physicians and 33 nurses; 42 in transplant setting, 28 in general oncology/hematology, 9 in ICU, 1 unknown; mean experience: 6 years, SD = 0-25). Participants, regardless of profession, highly agreed to integrate SPC for patients with poor prognosis (Yes = 96%), but a majority would not do so for good prognosis patients (No = 63%). In 'fifty-fifty' prognosis, there was no agreement among physicians, whereas nurses would mostly integrate SPC. The preferred integration model for patients with poor or 'fifty-fifty' prognosis was a co-management for specific patients' needs. Participants primarily wanted palliative care specialists to support them in addressing life threat with patients. This study highlights the need to develop accurate integration criteria of SPC in the transplant trajectory, taking multi-professional perspectives into account.