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Psychosocial Study

Ethical reasoning about patient eligibility in allogeneic BMT based on psychosocial criteria

Bone Marrow Transplantation volume 44, pages 607–612 (2009)Cite this article

Abstract

Chairpersons of the hospital ethics committees (HECs) and BMT clinicians were compared with regard to their willingness to proceed with allogeneic BMT given select psychosocial risk factors. A self-administered questionnaire was sent to 62 HEC chairpersons at hospitals with an accredited BMT program; the response rate was 37%. Items included background information, followed by six case vignettes from a 2006 national survey on which BMT physicians, nurses and social workers agreed not to proceed with allogeneic BMT on the basis of the following risk factors: suicidal ideation; use of addictive, illicit drugs; history of non-compliance; absence of a caregiver; alcoholism; and mild dementia from early onset of Alzheimer's disease. Opinions regarding transplant differed in one case only, in a patient with mild dementia; 27% of HEC chairpersons recommended not proceeding with BMT, which was significantly lower than that of nurses (68%, P<0.001), physicians (63.5%, P<0.001) and social workers (51.9%, P=0.05). Qualitative data show patterns of informal reasoning, linking transplant decisions to patient's responsibility for their psychosocial risk factor(s), as well as to medical benefit and outcome.

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References

  1. Bolwell BJ . Are predictive factors clinically useful in bone marrow transplantation? Bone Marrow Transplant 2003; 32: 853–861.

    Article  CAS  PubMed  Google Scholar 

  2. Foster LW, McLellan L, Rybicki L, Dabney J, Welsh E, Bolwell B . Allogeneic BMT and patient eligibility based on psychosocial criteria: a survey of BMT professionals. Bone Marrow Transplant 2006; 37: 223–228.

    Article  CAS  PubMed  Google Scholar 

  3. Schulz-Kindermann F, Hennings U, Ramm G, Zander AR, Hasenbring M . The role of biomedical and psychosocial factors for the prediction of pain and distress in patients undergoing therapy and BMT/PBSCT. Bone Marrow Transplant 2002; 29: 341–351.

    Article  CAS  PubMed  Google Scholar 

  4. Syrjala KL, Chapko MK, Vitaliano PP, Cummings C, Sullivan KM . Recovery after allogeneic marrow transplantation: prospective study of predictors of long-term physical and psychosocial functioning. Bone Marrow Transplant 1993; 11: 319–327.

    CAS  PubMed  Google Scholar 

  5. Sullivan AK, Szkrumelak N, Hoffman LH . Psychological risk factors and early complications after bone marrow transplantation in adults. Bone Marrow Transplant 1999; 24: 1109–1120.

    Article  CAS  PubMed  Google Scholar 

  6. Gregurek R, Labar B, Mrsic M, Batinic D, Ladika I, Bogdanic V et al. Anxiety as a possible predictor of acute GVHD. Bone Marrow Transplant 1996; 18: 585–589.

    CAS  PubMed  Google Scholar 

  7. Colon EA, Callies AL, Popkin MK, McGlave PB . Depressed mood and other variable related to bone marrow transplantation survival in acute leukemia. Psychosomatics 1991; 32: 420–425.

    Article  CAS  PubMed  Google Scholar 

  8. Loberiza FR, Rizzo JD, Bredeson CN, Antin JH, Horowitz MM, Weeks JC et al. Association of depressive syndrome and early deaths among patients after stem-cell transplantation for malignant diseases. J Clin Oncol 2002; 20: 2118–2126.

    Article  PubMed  Google Scholar 

  9. Foster LW, McLellan LJ, Rybicki LA, Sassano DA, Hsu A, Bolwell BJ . Survival of allogeneic bone marrow transplant patients: the relative importance of in-hospital lay care-partner support. Journal of Psychosoc Oncol 2004; 22: 1–20.

    Article  Google Scholar 

  10. Andrykowski MA, Brady MJ, Henslee-Downey PJ . Psychosocial factors predictive of survival after allogeneic bone marrow transplantation for leukemia. Psychosom Med 1994; 56: 432–439.

    Article  CAS  PubMed  Google Scholar 

  11. Molassiotis A, van den Akker OBA, Milligan DW, Goldman JM . Symptom distress, coping style and biological variables as predictors of survival after bone marrow transplantation. J Psychosom Res 1997; 42: 275–285.

    Article  CAS  PubMed  Google Scholar 

  12. Neuser J . Personality and survival time after bone marrow transplantation. J Psychosom Res 1988; 32: 451–455.

    Article  CAS  PubMed  Google Scholar 

  13. Tschuschke V, Hertenstein B, Arnold R, Bunjes D, Denzinger R, Kaechele H . Associations between coping and survival time of adult leukemia patients receiving allogeneic bone marrow transplantation: results of a prospective study. J Psychosom Res 2001; 50: 277–285.

    Article  CAS  PubMed  Google Scholar 

  14. Chang G, Antin H, Orav EJ, Randall U, McGarigle C, Behr HM . Substance abuse and bone marrow transplant. Am J Drug Alcohol Abuse 1997; 23: 301–308.

    Article  CAS  PubMed  Google Scholar 

  15. Hoodin F, Kalbfleisch KR, Thrornton J, Ratanatharathorn V . Psychosocial influences on 305 adults’ survival after bone marrow transplantation; depression, smoking, and behavioral self- regulation. J Psychosom Res 2004; 57: 145–154.

    Article  PubMed  Google Scholar 

  16. Dossetor JB . Psychosocial patient selection criteria in clinical practice guidelines: an ethical basis for rationing? CMAJ 2001; 164: 642–643.

    CAS  PubMed  PubMed Central  Google Scholar 

  17. Bardon A . Ethics education and value prioritization among members of US hospital ethics committees. Kennedy Institute of Ethics Journal 2004; 14: 395–406.

    Article  PubMed  Google Scholar 

  18. Waller B . Responsibility and health. Cam Q Healthc Ethics 2005; 14: 177–188.

    Article  Google Scholar 

  19. Sadler TD, Zeidler DL . Patterns of informal reasoning in the context of socioscientific decision making. J Res Sci Teach 2005; 42: 112–138.

    Article  Google Scholar 

  20. Baker R, McCullough L . Medical ethics’ appropriation of moral philosophy: The case of the sympathetic and the unsympathetic physician. Kennedy Inst Ethics J 2007; 17: 3–22.

    Article  PubMed  Google Scholar 

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Authors and Affiliations

  1. School of Social Work, Cleveland State University, Cleveland, OH, USA

    L W Foster & T Tyler

  2. Department of Hematology and Medical Oncology, Taussig Cancer Center, Cleveland Clinic, Cleveland, OH, USA

    L McLellan & B J Bolwell

  3. Department of Quantitative Health Sciences, Cleveland Clinic, Cleveland, OH, USA

    L Rybicki

Authors
  1. L W Foster
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  2. L McLellan
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  3. L Rybicki
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  4. T Tyler
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  5. B J Bolwell
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Correspondence to L W Foster.

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Foster, L., McLellan, L., Rybicki, L. et al. Ethical reasoning about patient eligibility in allogeneic BMT based on psychosocial criteria. Bone Marrow Transplant 44, 607–612 (2009). https://doi.org/10.1038/bmt.2009.58

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