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

Foster, Lisa; McLellan, Linda; Rybicki, Lisa; Tyler, Tim; Bolwell, Brian J.

doi:10.1038/bmt.2009.58

Cited by 15 publications

(3 citation statements)

References 17 publications

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“…1-8 As a result, pre-transplant psychosocial screening, i.e. the identification of psychosocially vulnerable patients, has been integrated into the HCT process at nearly all transplant centers 9 although the value of screening is uncertain. Psychosocial screening broadly includes an assessment of an individual’s resilience, mental health, compliance, social support, coping and health behaviors and offers information to clinicians to guide therapeutic interventions and contribute to eligibility decisions.…”

Section: Introductionmentioning

confidence: 99%

Psychosocial risk predicts high readmission rates for hematopoietic cell transplant recipients

Richardson

Huang

McGinty

et al. 2018

Bone Marrow Transplant

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Hematopoietic cell transplantation (HCT) is an intensive treatment resulting in disease control however subsequent psychosocial distress is common. Screening for psychosocial risk factors that contribute to morbidity is underutilized; moreover, the value in screening is uncertain. We performed a retrospective study of 395 HCT patients who were screened for psychosocial risk using the Transplant Evaluation Rating Scale (TERS). Patients were classified by psychosocial risk as no-risk (TERS = 26.5, 52%) vs. at-risk (TERS > 26.5, 48%), with at-risk patients stratified by cumulative deficits into mild risk (TERS = 27-35.5, 39%) and moderate risk (TERS > 35.5, 9%). At-risk patients were more likely to be readmitted within 90 days (mild risk HR = 1.62, p = 0.02, moderate risk HR = 2.50, p = 0.002). Prior psychiatric history (HR = 1.81, p = 0.002) and poor coping skills (HR = 1.64, p = 0.04) also influenced readmission. At-risk patients were more likely to be readmitted for infection (no-risk = 12% vs. at-risk = 25%, p = 0.002). Pre-HCT screening with the TERS did not predict survival or length of stay although at-risk patients are at a heighted risk of readmission. Implementing strategies to reduce readmission in higher risk patients is warranted.

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Section: Introductionmentioning

confidence: 99%

Psychosocial risk predicts high readmission rates for hematopoietic cell transplant recipients

Richardson

Huang

McGinty

et al. 2018

Bone Marrow Transplant

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“…Similarly, the deleterious outcomes of poor adherence have been described in pediatric bone marrow transplant recipients, 33 and while psychosocial factors including adherence may be considered in bone marrow transplant candidates, there is not a universally standard approach. 34 Also not included in the coding schema was the idea of complex riskbenefit analysis as applied to an invasive procedure. For example, an ethics consultation was called to help determine whether it was ethical to place a ventriculoperitoneal shunt to improve quality of life in a terminal patient, knowing that the risk of mortality during surgery was high and the benefit was likely incremental.…”

Section: Discussionmentioning

confidence: 99%

Content review of pediatric ethics consultations at a cancer center

Winter

Friedman

McCabe

et al. 2019

Pediatric Blood & Cancer

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Background/objectives Ethical challenges in pediatric oncology arise at every stage of illness. However, there are sparse data on the content of and reason for ethics consultations in the field. We sought to evaluate the content and characteristics of ethics consultations in pediatric patients at a cancer center. Design/methods We retrospectively identified ethics consultations performed for patients diagnosed with cancer at ≤21 years of age who were treated in the Department of Pediatrics from 2007 to 2017. Using an established coding schema, two independent reviewers analyzed the content of ethics consultation notes and identified core ethical issues and relevant contextual issues. Demographic, clinical, and consultation‐specific data were also collected. Results Thirty‐five consultations were performed for 32 unique patients. The most commonly identified ethical issues were obligation to provide nonbeneficial treatment (29%) and resuscitation preferences (26%). Communication conflicts were the most commonly identified contextual issue (40%). There were two themes that emerged repeatedly but were not a part of the original coding schema—four consultations (11%) that involved physicians questioning their obligation to provide potentially toxic treatment in the setting of poor patient/parent compliance, and two consultations (6%) related to complex risk‐benefit analysis in the setting of an invasive procedure with uncertain benefit. Conclusions Pediatric ethics consultations are infrequent at this specialty cancer hospital. Ethical issues focused on treatment and end‐of‐life care and included a diversity of communication conflicts.

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“…24 And, as study findings indicate, when making decisions about proceeding with BMT, more important than the PACT final rating (or the rater's overall impressions of the candidate's acceptability for transplant) are subscales representing aspects of psychosocial importance, such as family or support system stability, patient compliance, drug and alcohol use, and the potential effect of these on medical outcomes. The case illustration underscores the utility of the PACT subscales for screening a cluster of psychosocial issues that may combine as risk factors, reaching a threshold level beyond which allogeneic BMT cannot be justified on the basis of medical utility or possible medical benefit and outcome.…”

mentioning

confidence: 99%

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

Foster

McLellan²,

Rybicki

et al. 2009

Bone Marrow Transplant

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. The PACT has eight subscales, each rated on a 5-point scale, and an initial and final rating independently based on the rater's overall impressions of the candidate's acceptability for transplant. This exploratory study assessed the clinical utility of the PACT scale for psychosocial screening in allogeneic BMT. Associations of the PACT subscales and the final rating with sixteen post transplant medical outcomes were examined using the Jonchkheere-Terpstra test, the Cochran-Armitage test or the Cox proportional hazards analysis. Significant relationships (Pp0.05) between PACT subscales and medical outcomes are as follows: better compliance with medications and medical advice associates with lower in-hospital mortality, shorter length of stay and readmission duration, and faster neutrophil and platelet engraftment; better scores on drug/alcohol use associates with faster platelet engraftment; better scores on family/support system availability and on relevant knowledge and receptiveness to education associates with decreased risk of mortality. The final rating score and medical outcomes are not significantly related; however, study findings underscore the prognostic value of the PACT subscales and the potential utility for screening of BMT candidates.

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

Cited by 15 publications

References 17 publications

Psychosocial risk predicts high readmission rates for hematopoietic cell transplant recipients

Psychosocial risk predicts high readmission rates for hematopoietic cell transplant recipients

Content review of pediatric ethics consultations at a cancer center

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

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