Perceptions of Specialty Palliative Care and Its Role in Pediatric Stem
Cell Transplant: A Multi-Disciplinary Qualitative Study
Abstract
Background Consultation of specialty palliative care remains uncommon in
pediatric stem cell transplant (SCT) despite growing evidence that early
integration of palliative care improves outcomes in patients with
advanced cancers or undergoing SCT. Little is known about how
multidisciplinary pediatric SCT teams perceive palliative care and its
role in SCT. Procedure We conducted semi-structured interviews of
members of a multi-disciplinary SCT team to understand their perceptions
of palliative care, how specialty palliative care is integrated into
SCT, and to identify barriers to increased integration. Eligible
participants included physicians, nurses, nurse practitioners, social
workers, and child life specialists. Data was analyzed using thematic
analysis. Results Four major themes were identified. First, SCT team
members held a favorable perception of the palliative care team. Second,
participants desired increased palliative care integration in SCT.
Third, participants believed that the palliative care team had
insufficient resources to care for the large number of SCT patients
which led to the SCT team limiting palliative care consultation. And,
finally, the lack of a standardized palliative care consultation process
prevented greater integration of palliative care in SCT. Conclusions SCT
team members held a favorable perception of palliative care and saw a
role for greater palliative care integration throughout the SCT course.
We identified modifiable barriers to greater palliative care
integration. SCT teams who desire greater palliative care integration
may adapt and implement an existing model of palliative care integration
in order to improve standardization and increase integration of
specialty palliative care in SCT.