# A cross-sectional survey on health care professionals’ approaches, challenges, and support needs when addressing life threat with recipients of an allogeneic hematopoietic stem cell transplantation and with their relatives

## TL;DR

This study explores how healthcare professionals handle discussions about life-threatening risks with patients who have undergone a specific type of stem cell transplant and their families.

## Contribution

The study introduces a novel survey approach to assess healthcare professionals' communication strategies and support needs regarding life-threatening risks in stem cell transplant patients.

## Key findings

- Physicians tend to address life-threatening issues proactively, while nurses often do so when prompted by patients.
- A significant challenge is discussing death risks with patients who suppress the topic, and more time and mentorship are needed to support healthcare professionals.
- Healthcare professionals' approaches to life-threatening discussions correlate weakly with their personal attitudes toward death.

## Abstract

Patients treated with an allogeneic hematopoietic stem cell transplantation (allo-SCT) face a significant mortality risk, which might trigger existential distress. We aimed to investigate how hematology health care professionals (HCPs) address life-threatening conditions with allo-SCT recipients and their relatives, and what are challenging and supportive aspects. We conducted a multicenter cross-sectional survey, assessing: (1) HCPs’ approaches to address life threat, using a self-developed questionnaire with 19 items categorized in four dimensions (proactive, cautious, reactive, avoiding), (2) challenges/support needs, using self-developed multiple-choice questions, and (3) personal attitudes towards death (Death Acceptance subscale of the Life Attitude Profile-Revised; Death Attitude Profile-Revised). Statistics included association, regression and exploratory factor analysis. We included 104 participants (52 physicians, 45 nurses, 7 psycho-oncologists) from the settings of SCT, general hematology and intensive care. Physicians predominantly addressed life threat proactively, while nurses tended to raise the topic when prompted by patients or a clinical worsening. Overall, 10% of HCPs stated to avoid the topic, even in case of a high risk of death. HCPs’ approaches correlated weakly with their attitudes towards death. A main challenge was to talk with patients/relatives repressing the risk of death (72%). More time resources for these conversations (71%), and mentoring by palliative-care specialists (67%) or psycho-oncologists (65%) were the most frequent support needs. This comprehensive survey reveals strong differences between professions in addressing life threat, and possible influence from personal death attitudes. Further confirmatory research in larger samples is needed to tailor communication trainings on life threat in multi-professional teams. Registration:German Clinical Trials Register, DRKS00027290, date of registration: 2022-01-10.

The online version contains supplementary material available at 10.1007/s00277-025-06211-6.