In caring for children undergoing stem cell transplantation, Griffin Collins, MD, often sees a clear need for palliative care.
“Stem cell transplant is a very high-risk procedure. The process is incredibly hard. The patients suffer a lot, and they’ve already suffered a lot,” says Collins, a pediatric hematologist-oncologist at UCSF Benioff Children’s Hospital Oakland.
Yet relatively few patients receive early palliative care; of those who do, many never receive comprehensive palliative care.1
“Patients and families coming to stem cell transplant are holding on to both a hope for cure and worries about suffering and treatment-related complications,” Collins explains. “The heart of what we do as palliative care providers is recognizing and managing suffering in all of its forms.”
Collins and colleagues surveyed members of the stem cell transplant team at UCSF Benioff Children’s Hospital to find out how they perceived palliative care.2 Participants identified two important themes.
First, team members expressed a favorable view of the palliative care team. These members had long suspected there were so few consults because the stem cell transplant team failed to recognize the extent of suffering patients endured, or because the transplant team believed they carried the same skill set as palliative care specialists. In fact, says Collins, “there was willingness and even eagerness from the majority of participants across disciplines to increase palliative care integration in stem cell transplant.”
Second, participants believed the palliative care team had insufficient resources to care for the many stem cell transplant patients. It turned out the stem cell transplant team was reluctant to request consults routinely from a service they saw as overloaded. “A major ethical implication is the distribution of palliative care resources,” Collins says.
Pediatric palliative care teams are limited in many medical centers. If stem cell transplant programs were to suddenly start asking for palliative care consults, then palliative care would be stretched even thinner.
The answer, says Collins, is for institutions to invest in additional palliative care resources. “This is something ethicists can advocate for,” he says.
One obstacle is palliative care teams do not directly generate significant revenue. Thus, the challenge is to argue for more palliative care based on other arguments.
Collins says hospital leaders must understand that “palliative care teams provide intangible benefits for patients and staff: improved patient satisfaction, reduced burnout, and reduced healthcare costs through reductions in average length of stay and readmissions.”
REFERENCES
- Ruiz M, Reynolds P, Marranzini R, et al. Role of early palliative care interventions in hematological malignancies and bone marrow transplant patients: Barriers and potential solutions. Am J Hosp Palliat Care 2018;35:1456-1460.
- Collins GS, Beaman H, Ho AM, et al. Perceptions of specialty palliative care and its role in pediatric stem cell transplant: A multidisciplinary qualitative study. Pediatr Blood Cancer 2022;69:e29424.
Palliative care teams can shorten length of stay, prevent readmissions, improve patient satisfaction, lower costs, and reduce burnout rates.
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