Photo Credit: Jacob Wackerhausen
We’ve known for some time of two randomized trials that when you integrate palliative care with transplant, you get palliative care clinicians to see people while they’re in the hospital, so that you improve quality of life and you reduce symptom burden, both physical and psychological. So that’s a known, established finding. What I hope to do in this study was to tease apart for the people who respond, or their factors associated with that, and what we defined is quality of life in the hospital. We looked at early quality of life response and the findings were interesting. I think we found there actually weren’t a ton of sociodemographic factors associated with response.
If people belonged to a minoritized race, they’d seem to have more likely to have an early quality of life response when receiving early palliative care. And then the other responses were actually more so based on people’s baseline symptoms. So if you came in with a lower baseline quality of life where you had higher symptoms of distress, notably depression, that those patients were more likely to have early benefit from specialty palliative care. And so you asked about the implications of this. I think this was an exploratory analysis, so it’s hard to say anything definitively, but if we were to extrapolate this out, we were to say, if in the future we wanted to identify who are the people most likely to benefit, you can actually use patient reported symptoms at the time of admission for transplant to sort of say, Hey, you might somebody who really, we really need to think about early diet of care from either a physical or physical symptom or a psychological subject perspective.
I think one thing we know is that specialty palliative care improves people’s lived experience. However, there just aren’t enough palliative care clinicians so that everybody getting a transplant or intensive therapy will get a consult. It’s just not a feasible, we know it’s effective, it’s just not scaling. And so if you were looking to develop a program to say, alright, well, I know I can’t give it to everybody, but if I survey people before they come into the hospital and get a sense of how they’re doing, maybe that could be a way, I can say, well, maybe I had 10 people coming to transplant and I know two are really struggling even before we start conditioning. Maybe those are people that could benefit from specialty palliative care. So that could be one way to do it.
The other approach could be we could train clinicians who are transplant clinicians to be able to identify and administer some of those palliative care domains themselves. And I think that that gets into some of the other findings of the study in which we saw that it was the education and the coping pieces that patients who responded early to palliative care, those were the domains that they received more. And the good news about that is that you could train people on that. It’s spending extra time at the bedside talking about the expected course. It’s figuring out people, how do they cope with things and how to better support them for their prior experiences, but with this new intense thing that they’re going through. So those are just two potential ways you could take these results and sort of say, how do I build a supportive care program, whether it’s targeted specialty palliative care, or actually training transplant clinicians to deliver palliative care demands themselves.
