Health-Related Values Discussions With Patients Receiving Allogeneic and Autologous Stem Cell Transplant and Chimeric Antigen Receptor Therapy (CAR-T): Implementation of an Early Nurse Practitioner-Led Primary Palliative Care Intervention.

Abstract

Patients undergoing hematopoietic stem cell transplant and chimeric antigen receptor-T cell therapy face significant uncertainty, distress, risk of serious treatment-related complications, and disease relapse. Although palliative care and advance care planning offer clear benefits, both remain underutilized or delayed in this patient population. To address this gap, a nurse practitioner (NP)-led primary palliative care intervention was implemented in the outpatient Bone Marrow Transplant and Cellular Therapy Services at a comprehensive cancer center. This paper provides an overview of the program model, involving NP-led health-related values and care preferences discussions with patients and their families. This highlights the pivotal role of NPs in delivering primary palliative care by integrating values-based discussions into routine oncology practice. Future goals include evaluating the intervention's impact on patient and caregiver outcomes, clinician understanding, care alignment with patient's goals, advance directive completion, and high-intensity care at the end of life.