A conceptual framework of the psychosocial elements that should be assessed in candidates for hematopoietic cell transplant: Social workers' and psychologists' perspectives

Integrating Social Work Throughout the Hematopoietic Cell Transplantation Trajectory to Improve Patient and Caregiver Outcomes

Clinical social workers possess a dual skillset of social care and mental health care and are the largest group of psychosocial care providers in oncology. Psychosocial care is an integral component of quality healthcare. The prevailing model of psychosocial care in oncology is a brief consultation for patients who screen positive for distress at a particular timepoint. This model is insufficient for hematopoietic cell transplantation (HCT). Patients and caregivers have evolving needs throughout the HCT process, and psychosocial care models should meet these needs. This white paper, a collaboration between the Association of Oncology Social Work's Blood Cancer/HCT Special Interest Group and the American Society for Transplantation and Cellular Therapy's Social Work Special Interest Group, presents a gold standard model for the integration of social work in HCT. The model structures social work visits in every phase of HCT and integrates social workers within the interdisciplinary team. In this model, social workers conduct assessments with all patients (autologous and allogeneic) at the initial HCT consultation and again during work-up. They subsequently follow all patients and caregivers as they progress through transplant. This ongoing management reduces the burden on other team members to identify and address psychosocial needs. It also creates many organic opportunities to implement interventions to improve outcomes. There is a need to build institutional capacity for psychosocial care. Strategies that centers can use to build capacity are presented. As a complex clinical intervention, the gold standard model is well-suited for implementation research within a quality improvement framework.

Reexamining "psychosocial clearance": A procedural framework for psychosocial evaluation in liver transplantation

Psychosocial and "nonmedical" phenomena are commonly encountered in liver transplantation (LT) evaluations. They are simultaneously crucial decision-making factors and some of the most difficult and controversial clinical matters clinicians confront. Epidemiology, societal trends, and the preponderance of psychological and behavioral factors underpinning common end-stage liver diseases ensure that LT teams will continue to encounter highly complex psychosocial patient presentations. Psychosocial policies, practices, and opinions vary widely among clinicians and LT centers. Liver clinicians already report insufficient psychosocial expertise, which creates a large gap between the stark need for psychosocial expansion, improvement, and innovation in LT and the lack of accompanying guidance on how to achieve it. While the clinical domains of an LT psychosocial evaluation have been well-described, few articles analyze the procedures by which teams determine candidates' "psychosocial clearance" and no conceptual frameworks exist. This article proposes a framework of core domains of psychosocial evaluation procedures, common pitfalls, and practical improvement strategies.

Psychosocial assessment practices for hematopoietic stem cell transplantation: a national survey study

Psychosocial health predicts and contributes to medical outcomes for patients undergoing hematopoietic stem cell transplantation (HSCT). Yet, there are no standards for psychosocial assessments or support for both patients and caregivers across the care continuum. To examine the current state of psychosocial care, clinicians were sent a survey of their psychosocial assessment practices for patients and caregivers undergoing HSCT via the Listservs of professional organizations. Descriptive statistics and bivariate analyses were performed to summarize the findings. While 96% of participants reported routine pre-HSCT psychosocial assessment of patients, only 10.6% routinely used a validated transplant risk-assessment measure. Just 27% routinely performed follow-up psychosocial assessments. In contrast, only 47% of participants routinely assessed the psychosocial needs of family caregivers pre-HSCT, and 13% routinely performed follow-up assessments for caregivers. Most (90%) reported social workers were the primary providers of assessments. While patient-report measures were used for evaluation, the majority of assessments were clinical interviews. No significant differences were found between programs that treated adult and pediatric patients versus those only treating adult patients. Our findings highlight the lack of standard psychosocial practices for patients and family caregivers undergoing HSCT and we offer recommendations to fill this gap.

Psychosocial Assessment Practices for Hematopoietic Stem Cell Transplantation: A National Survey Study

Psychosocial health predicts and contributes to medical outcomes for patients undergoing hematopoietic stem cell transplantation (HSCT). Yet, there are no standards for psychosocial assessments or support for both patients and caregivers across the care continuum. To examine the current state of psychosocial care, clinicians were sent a survey of their psychosocial assessment practices for patients and caregivers undergoing HSCT via the Listservs of professional organizations. Descriptive statistics and bivariate analyses were performed to summarize the findings. While 96% of participants reported routine pre-HSCT psychosocial assessment of patients, only 10.6% routinely used a validated transplant risk-assessment measure. Just 27% routinely performed follow-up psychosocial assessments. In contrast, only 47% of participants routinely assessed the psychosocial needs of family caregivers pre-HSCT, and 13% routinely performed follow-up assessments for caregivers. Most (90%) reported social workers were the primary providers of assessments. While patient-report measures were used for evaluation, the majority of assessments were clinical interviews. No significant differences were found between programs that treated adult and pediatric patients versus those only treating adult patients. Our findings highlight the lack of standard psychosocial practices for patients and family caregivers undergoing HSCT and we offer recommendations to fill this gap.