Palliative Care in Hematologic Oncology Needs Assessment
As patients with hematologic malignancies further enter the scope of practice for palliative medicine physicians, it is increasingly important to have an accurate view of their needs. Historically, there is a paucity of research examining symptom or psychosocial burden in this cohort. Even fewer studies explore the experience and perceptions of frontline hematology providers. As our Geriatric and Palliative Medicine team at North Shore University Hospital (NSUH) embarked upon a collaborative Supportive Care model on our hospital’s dedicated Leukemia and Bone Marrow units, it was important to gain insight from providers about this population.
We conducted a supportive care needs assessment survey of the staff (faculty, fellows, nurse practitioners, nurses, social workers, and case management) from the Leukemia and Bone Marrow units. The survey encompassed eighteen domains and attempted to assess their prevalence in patients according to the Hematology team. It included symptom burden, social and functional complexities, advance care planning, and goals of care. Additionally, free text responses were elicited to capture personalized staff input about challenges in caring for these patients.
We received a response rate of 30% (30/101) with respondents primarily being nurses. It revealed which domains were most commonly seen by the team. The domains most often selected as being present "frequently" or "almost always" in their patient population were fatigue (97%), nutritional issues (96%), gastrointestinal issues (93%), anxiety (80%), goals of care (69%), and advance directives (69%). Furthermore, we learned that challenges with symptom management (the chronicity of burden and pain) were problematic for staff. The team expressed that managing patients’ expectations about the impact of chemotherapy is a key area of importance. Lastly, clear communication with patients throughout treatment and caregiver support were consistent concerns from the hematology team.
Determining the four most prominent issues encountered by hematology staff were fatigue, nutritional, gastrointestinal, and anxiety can help to refine the symptom screening in these patients. Moreover, communication and medical decision making concerns were other noted areas of importance. These results underscore the necessity of assessing frontline provider perspectives while treating those with hematologic malignancies to guide future educational and clinical initiatives.
- Gene A. DeCastro, MD
- Assistant Professor
- Northwell HealthNorth Shore Manhasset University Hospital
- 300 Community Dr.
- Manhasset, NY 10034
- (516) 562-3015
- Bridget Earle, MD