Psychosocial assessment of candidates for hematopoietic cell transplantation: A national survey of centers' practices

Abstract

Objective This study characterizes pre‐hematopoietic cell transplant psychosocial assessment practices with adult patients at centers in the U.S. An online, cross‐sectional survey was conducted to describe the content and process of assessment including the high risk factors that influence transplant eligibility and how eligibility decisions are made. Methods Psychosocial professionals (one per center) were invited to participate by sharing their center's practice. The questionnaire was developed by the researchers and pre‐tested with a group of hematopoietic cell transplantation social workers. Univariate statistics were used to describe the sample as well as the content and process of psychosocial assessment. Content analysis was conducted on textual data. Results A total of 90 centers had one psychosocial professional that responded. There was general consistency among centers about the major psychosocial components that are assessed, but variation occurred regarding what, if any, standardized measures were used. Approximately half of centers that used standardized measures used the Psychosocial Assessment of Candidates for Transplantation, Transplant Evaluation Rating Scale, or Stanford Integrated Psychosocial Assessment for transplantation to rate overall psychosocial risk. Most respondents (86%) reported that their center has declined an otherwise medically eligible patient due to psychosocial risk factors. Risk factors most frequently reported as potentially influencing eligibility included no caregiver/poor support system, illicit drug use, and serious, untreated mental illness. Conclusions Study findings provide a fuller understanding of psychosocial assessment practices, including the challenging ethical issue of psychosocial eligibility, and will help inform best practices.

Psychosocial assessment practices for hematopoietic stem cell transplantation: a national survey study

“…39,43 Standardized psychosocial assessments for HSCT recipients and their caregivers are lacking. 12 Clinicians who completed our survey reported using 23 different measures, with the Patient Health Questionnaire 9 (PHQ-9) most commonly used. Despite existing validated pre-transplant psychosocial risk-prediction measures, such as the TERS, SIPAT, and PACT, very few transplant centers reported consistent use of these measures, which are powerful predictors of transplant outcomes, often showing better predictive validity than medical comorbidities for survival and other key outcomes post-transplant.…”

“…Previous reports focused exclusively on pre-transplant assessment: one identi ed whether adult and pediatric programs require psychiatric evaluation, 11 and another described psychosocial assessment practices in adult programs only. 12 Some studies have found that pre-transplant psychosocial risk assessment tools such as the Transplant Evaluation Rating Scale (TERS), the Stanford Integrated Psychosocial Assessment for Transplantation (SIPAT), and the Psychosocial Assessment of Candidates for Transplant (PACT) predict post-transplant outcomes, including survival, medical adherence, delirium, ICU transfer, readmissions, hospital length of stay, and quality of life. [13][14][15][16][17][18][19][20][21] Since many psychosocial risk factors (e.g., adherence to medical regimens, cognition, quality of family support) are challenging to obtain from patients' self-report due to recall bias, these risk assessments are often completed by specialty mental health clinicians.…”

Family-focused practice and policy recommendations to improve the inpatient experience for patients undergoing a stem cell transplant.

“…The depth and breadth of biopsychosocial assessment varies among HCT centers. Insufficient biopsychosocial assessment limits the provider’s understanding of how the HCT experience affects a particular patient and limits that patient’s knowledge about how the biological process of the illness and psychosocial demands will impact them (Randall et al, 2022). It is essential to conduct in-depth assessments at pretransplant that include the patient’s phase of life, current ability to perform activities of daily living, and the quality of their relationships with their family members.…”

Assessing and Preparing Patients for Hematopoietic Stem Cell Transplant in Canada: An Environmental Scan of Psychosocial Care

“…Previous literature recognizes that many centres evaluate pre-transplant psychosocial factors to some extent [ 8 ]. However, little evidence exists to inform best practice: only one study surveyed the practices of psychosocial assessment across US centres [ 13 ].…”

“…The need exists for HCT programs to support the psychosocial wellbeing of their patients and caregivers, and specific guidance in this area in the existing literature is sparse [ 6 , 10 , 13 , 14 , 15 , 16 ]. To understand the pre-HCT psychosocial services provided to patients and caregivers across Canada and inform pre-HCT psychosocial program development at our centre, we conducted an environmental scan of Canadian HCT programs.…”