Palliative Care Conversations With Stem Cell Transplant Recipients

Betty R. Ferrell, PhD, RN


January 23, 2014

End-of-Life Decision Making in Hematopoietic Cell Transplantation Recipients

Tee ME, Balmaceda GZ, Granada MA, Fowler CS, Payne JK
Clin J Oncol Nurs. 2013;17:640-646

Treatment Options in Hematopoietic Cell Transplantation

Discussions about futile treatment options for patients undergoing hematopoietic cell transplantation (HCT) are known to be difficult for healthcare providers. It is well established that these discussions are often not initiated before transplantation and occur only after a patient's healthcare status deteriorates post-transplant.

Nurses are in a key position to provide support and advocate for patients and their families in end-of-life (EOL) decisions. Tee and colleagues describe how nurses, as patient advocates, can implement nursing education in schools and in the workplace to support these new responsibilities. This article includes a review of the literature related to the nurse's role in the transition from active treatment to EOL care in the HCT population.


Although there has been extensive application of palliative care in oncology,[1,2,3,4,5] most cancer care settings report that palliative care advances have occurred largely in the solid-tumor populations rather than in patients with hematologic cancer. Patients undergoing HCT and their healthcare providers are often focused on the goal of cure. Unfortunately, this focus often denies patients access to palliative care. This is a concern, given that HCT patients experience many symptoms and many die of their disease.

This article is an excellent review of palliative care needs in the HCT population. The authors emphasize the importance of excellent communication with patients about HCT risks and prognosis and the need for advance care planning. They also emphasize the need for education of professionals in HCT so that EOL care can be improved.



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