Background Advance care planning is frequently overlooked in haematological malignancies (LeBlanc, 2017. J Oncol Pract. 14:721). A challenging specialism, transition from curative to end of life can be rapid (Moreno-Alonso, Porta-Sales, Monforte-Royo, et al., 2018. Palliat Med. 32:79). An exploratory study conducted by the primary author proposed that advance care planning is essential for patients with a terminal diagnosis, but also patients undergoing potentially curative treatment carrying a significant mortality risk. Chimeric antigen receptor T-cell (CAR-T) therapy is an emerging complex treatment carrying significant risks (NHS England. CAR-T therapy [Internet]). Knowledge around post-procedure survivability and long term effects is limited (Kansagra, Frey, Bar, et al., 2018. Biol Blood Marrow Transplant. 25:76).
Aims The aim was to ensure patients are offered advance care planning prior to CAR-T. There was no robust process in place for advance care planning in CAR-T prior to this project. The aim was to provide a personalised, responsive service aimed at improved patient experience.
Methods Single centre exploratory study on perceived barriers and facilitators to advance care planning undertaken. Literature review. Planning and agreement to proceed, developing clinic template and patient evaluation tool (June-July 2021). Implementation/delivery (July 2021 onwards). Evaluation ongoing.
Results Patients referred and accepting service -100%. Patient satisfaction surveys– 100% improved understanding of advance care planning. 100% recommend the clinic. 100% felt service of value. Wider clinical team now shadowing service in order to utilise it within sub-specialisms.
Conclusions Advance care planning can occur at any point in the disease trajectory. If it took place pre-treatment, covering all possible outcomes, individuals may be better prepared for ‘worst case scenario’. This service has 100% positive feedback. It has the potential to increase the utilisation of advance care planning within CAR-T and more widely. The results indicate that the clinic has improved continuity and helped to provide patient focussed care (Evans, Poku, Pearce, et al., 2020. BMJ Open. 10:1). Education of and further support from palliative care specialists would be beneficial in the field of CAR-T therapy.
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