Nurse-Led Palliative Care Conversations Enhance HSCT and CAR-T Outcomes

At the 2026 ONS Annual Congress, researchers from Memorial Sloan Kettering Cancer Center presented findings highlighting the transformative impact of nurse-led primary palliative care (PPC) for patients undergoing hematopoietic stem cell transplantation (HSCT) and chimeric antigen receptor T-cell (CAR-T) therapy.

The study focused on the perceptions of oncology nurses and advanced practice providers (APPs) who implemented health-related values (HRV) discussions into routine care.

Historically, patients undergoing these intensive cellular therapies have lacked routine access to palliative care despite the high symptom burden and complexity of the treatments. To address this gap, an evidence-based PPC intervention was developed to empower frontline clinicians to initiate conversations focused on what matters most to their patients.

The health-related values (HRV) framework

The core of the intervention involved a structured HRV discussion. According to the poster, these discussions were guided by a specific set of questions designed to move beyond clinical metrics and into the personal values of the patient.

Key questions included asking patients what gives them strength when facing treatment, what "living well" means to them at this stage of their life, and what abilities are so critical that they cannot imagine living without them.Additionally, the intervention encouraged providers to discuss future care preferences, such as preferences for life-sustaining treatments in a crisis and identifying surrogate decision-makers.

By standardizing these questions, the intervention provided a roadmap for RNs and APPs to navigate sensitive topics that are often deferred in high-acuity settings.

Key findings and provider impact

The study analyzed the experiences of 32 APPs and RNs who completed a total of 78 HRV discussions. The findings were overwhelmingly positive regarding the clinical utility of the intervention. Providers reported that these discussions significantly increased their understanding of patient priorities, which in turn positively impacted treatment planning.

One of the most significant benefits identified was the strengthening of the patient-provider bond. Out of the participating clinicians, 29 felt that the HRV discussions enhanced their relationship with the patient and contributed to increased patient comfort.

Qualitative feedback from the providers described the intervention as the "foundation you build a relationship on" and noted that it helped "refocus on the human in front of you rather than just the treatment".

From a team perspective, the HRV discussions helped the multidisciplinary team establish attainable, patient-centered goals that everyone could work together to facilitate.

Identifying and overcoming barriers

Despite the benefits, the study identified several persistent barriers to implementing PPC in cellular therapy. The most common constraints reported by providers were time limitations, language barriers, and an initial apprehension regarding how to broach these difficult topics.

However, the authors noted that because specialty palliative care resources are often scarce, it is essential for oncology RNs and APPs to incorporate these primary palliative care skills into their daily practice. The study suggests that by empowering nurses to lead these discussions, the intervention not only benefits the patient but also has the potential to increase job satisfaction for the nursing staff.

Scalability and future directions

The researchers concluded that the HRV discussion model is highly scalable. While this study focused on the hematologic malignancy population, the framework can be adapted for other oncological specialties where patients face intensive treatments.

By integrating PPC into the standard workflow of HSCT and CAR-T units, oncology nurses can ensure that patient care remains aligned with individual values, even in the face of complex medical interventions. As one provider noted in the findings, the intervention "understood them on a deeper level—knew what was important to them and what they were anxious about. Was able to ease some of that anxiety".

Reference

1. Badigalupo A, Roney L, Ford K, et al. Early Primary Palliative Care (PPC) Intervention for Patients Undergoing Hematopoietic Stem Cell Transplantation (HSCT) and Chimeric Antigen Receptor T-cell (CAR-T) Therapy: Nurses’ and Advanced Practice Providers’ (APP) Perceptions. Poster presented at: ONS Annual Congress; May 2026.