Published on April 3, 2017
Professor Charles Craddock of the Queen Elizabeth University, Birmingham talks about the need for multiple consultations before deciding to undergo stem cell transplant. He recommends resources, techniques and talking points to go over with your healthcare team to empower you with the information to make a sensible decision. He describes the purpose of the first consultation and what to consider as a patient to make an informed decision.
This video has been supported by Pfizer, through an unrestricted educational grant to the Patient Empowerment Foundation.
Transcript | What Is Involved in a Stem Cell Transplant Consultation?
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I think it’s a series of conversations, and it’s conversations that are conducted by all the members of the team. Often the idea of transplant will have been noted before a patient’s referred for a transplant and patients may have even been given the excellent Bloodwise 7 steps book and some good information that others are producing.
But when we have our first consultation it’s to see the transplant permission but also to see a bone marrow transplant coordinator or nurse. And underpinning any good consultation is honesty and sensitivity. It’s very important I think that patients understand that the only really important thing is that we work towards an option that is best for them and that they’re right at the heart of this discussion — and also that we give them information in manageable chunks that empowers them to make the decision. So the decision is often made over a series of consultations.
But at the first meeting we would talk about the treatment options available in their disease, which might might, for example, be chemotherapy or a transplant or to do nothing. And one can talk through the benefits and risks of that. And then one needs to be thoughtful if it’s about an allogeneic transplant about discussing the importance of donor identification, about patient’s fitness and also that the disease is in some form of control before you go to transplant. And then I spend a few minutes just talking through the procedure, the transplant, the benefits, and the attending toxicities.
And after that, I’ll call my transplant coordinator. We’ll have a follow-up conversation, which you hope amplifies things that I’ve said. But I’m afraid sometimes it points out that what a lot I thought I said clearly was hopelessly frayed. So it’s very important that you have those twin-track conversations, and often patients find the way that nurses explain things certainly much more helpful than I do. And also I think patients sometimes find it much easier in their care to talk to nurses than to a doc.
And then we almost always will want to see the patients back again within a couple of weeks, perhaps a little longer depending on whether there’s a donor search going on and just go through again the progress we’ve made and give them an opportunity to ask further questions and try to move toward consolidating a plan. People often say it’s very daunting. But, in fact, although the decisions are sometimes quite complicated if you talk through it carefully and give people time, in my experience it almost always becomes very clear to patients in their care which way they want to go, and they will be in a position to make a decision they’re comfortable with. But you can’t do that in just one instantaneous conversation.