Allogeneic BMT and patient eligibility based on psychosocial criteria: a survey of BMT professionals

Abstract

BMT professionals were compared regarding their willingness to proceed with allogeneic BMT given select psychosocial issues. A questionnaire was sent to 660 physician members of ASBMT, 92 social work members of BMT Special Interest Group, Association of Oncology Social Work, and 626 nurse members of BMT Special Interest Group, Oncology Nursing Society; 597 responded with a response rate of 43.5%. Items included background information, followed by 17 case vignettes; each represented a different psychosocial issue to which respondents indicated whether or not they would recommend proceeding with allogeneic BMT. In every vignette, at least 10% of respondents indicated they would not proceed. In six vignettes, at least 64% indicated do not proceed: suicidal ideation (86.8%), uses addictive illicit drugs (81.7%), history of noncompliance (80.5%), no lay caregiver (69.3%), alcoholic (64.8%), and mild dementia/Alzheimer's (64.4%). In 10 vignettes, at least 73% indicated proceed. On four vignettes, professional subgroups differed in their recommendation on whether or not to proceed with allogeneic BMT. Qualitative data suggest that this decision is contingent on the perceived acuity, severity, and currency of the psychosocial issue, patient ability to comply with treatment given the issue, and its manageability as a risk factor for treatment related vulnerability and outcomes.

Utility of the psychosocial assessment of candidates for transplantation (PACT) scale in allogeneic BMT

“…What is noteworthy is the conceptual similarity between select PACT subscales (Compliance with Medications/Medical Advice, Risk for Psychopathology, Drug/Alcohol Use, and Family/Support System Availability), which associate significantly with medical outcomes in this study, and six psychosocial risk factors in an earlier study (history of non-compliance, suicidal ideation, mild dementia, alcoholic, use of illicit drugs, and no lay care partner), which were identified by a majority of BMT professionals nationwide as contraindicated for allogeneic transplant. 18 Also noteworthy is the finding that a decreased risk of mortality is associated with better scores on the PACT subscale Family and Support System Availability, which corroborates the earlier research finding that in-hospital lay care partner support is prognostic of patient survival in allogeneic BMT.…”

Ethical reasoning about patient eligibility in allogeneic BMT based on psychosocial criteria

“…Among 17 case vignettes presented in that survey, the consensus 'not to proceed' was achieved among the three professional groups for six cases. 2 As a follow-up, these six cases were included in this survey in which a selfadministered questionnaire was sent to HEC chairpersons at hospitals with a BMT program that performs adult allogeneic BMT and is accredited by the Foundation for the Accreditation of Cellular Therapy and designated as a National Marrow Donor Program Transplant Center. The list of HEC chairpersons was developed by calling the eligible hospitals and obtaining the names and mailing addresses; after three mailings, 23 of 62 chairpersons responded to the survey (37%).…”

“…16 BMT decisions are often conditional and patients are asked to take responsibility for improving their psychosocial risk factor(s) before proceeding to transplant. 2 Clinical reasoning using psychosocial criteria is consistent with, but secondary to, principles of medical utility when deciding who to transplant to achieve the best possible medical benefit and outcome. Furthermore, inasmuch as accessing BMT is an ethical as well as clinical issue, the inclusion of ethical reasoning is essential.…”

“…Reasoning behind such discussions seems clinical, such as the perceived acuity and severity of the psychosocial risk factor, patient's ability to comply with treatment protocols given the risk factor, and its manageability for treatmentrelated vulnerability and outcomes. 2 Although either associated with or predictive of patient outcomes in BMT, [3][4][5][6][7][8][9][10][11][12][13][14][15] psychosocial selection criteria raise concern that such criteria might 'y unwittingly hide value judgments that could unjustly limit an individual patient's access to treatments.' 16 BMT decisions are often conditional and patients are asked to take responsibility for improving their psychosocial risk factor(s) before proceeding to transplant.…”

Facteurs psychosociaux: impact sur l’indication de greffe de moelle osseuse

“…Des études américaines montrent cependant l'influence des aspects psychosociaux sur cette décision médicale [8], tout en constatant une grande variabilité dans les critères d'évaluation et de sélection des patients éligibles à la greffe selon les centres hospitaliers [11].…”