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April 10, 2026Blood Advances1 citationsOpen Access

An inpatient Serious Illness Care Program for older patients with hematologic malignancies: A single-arm pilot study

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MLMarissa LoCastroUniversity of Wisconsin–MadisonYWYing WangUniversity of Rochester Medical CenterABAndrea BaranUniversity of Rochester Medical Center

Key Points

  • The study aims to evaluate the feasibility of implementing a serious illness care program for older patients with hematologic malignancies while assessing advance directive completion.
  • Single-arm pilot study design in an inpatient setting.
  • Included patients aged 60 years and older with hematologic malignancies and caregivers.
  • Clinicians underwent virtual training on the serious illness care program.
  • Feasibility measured by patient retention rates and completion of advance directives.
  • Overall retention rate for SICP visits was 92.7%.
  • Advance directive completion increased from 23 health care proxy forms to 31 and from 7 MOLST forms to 20 within one year.
  • All serious illness care visits were documented, showing acceptable engagement from patients.
  • Numerical increase in advance care planning engagement was observed.

Abstract

The Serious Illness Care Program (SICP) is an evidence-based intervention designed to systemically implement serious illness conversations (SIC) into clinical practice. We previously piloted the SICP via telehealth for patients in the ambulatory setting. However, many patients with hematologic malignancies experience frequent hospitalizations, providing a key opportunity to conduct SICs in the inpatient setting. Assess the feasibility of an inpatient SICP and describe completion of advance directives and SIC documentation following SICP implementation. This was a single-arm pilot study including patients aged ³60 years with hematologic malignancies and their caregivers. Clinicians (advanced practitioners; hematology/oncology fellows) completed a 2-3-hour virtual training on the SICP. The primary outcome was feasibility (retention rate: % of consented patients who completed the SICP visit; >70% considered feasible). Secondary outcomes were advance directive completion health care proxy (HCP); Medical Order for Life Sustaining Treatment (MOLST) and documentation. We also collected data on advance care planning (ACP) engagement and disease understanding. We included 41 patients (mean age=68 years), 24 caregivers, and 22 clinicians; 38 SICP visits were completed (retention rate of 92.7%). The number of HCP and MOLST forms completed increased from 23 to 31 and from seven to 20 within one year of the SICP visits, respectively. All SICP visits were documented. ACP engagement numerically increased (p=0.24), and patients found the intervention to be acceptable. Patient estimates of life expectancy may have shifted after the SICP visit. The inpatient SICP was feasible, with potential increase in advance directive completion. NCT05433090.

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Cite This Study

LoCastro et al. (2026) studied this question.

synapsesocial.com/papers/69d895be6c1944d70ce06ca0https://doi.org/10.1182/bloodadvances.2025018200
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