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Blood, 1 October 2004, Vol. 104, No. 7, pp. 2194-2200.
Prepublished online as a Blood First Edition Paper on June 15, 2004; DOI 10.1182/blood-2003-07-2430.


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TRANSPLANTATION

Physicians' attitudes about quality-of-life issues in hematopoietic stem cell transplantation

Stephanie J. Lee, Steven Joffe, Haesook T. Kim, Gerard Socie, Andrew L. Gilman, John R. Wingard, Mary M. Horowitz, David Cella, and Karen L. Syrjala

From the Departments of Adult Oncology, Pediatrics, and Biostatistics, Dana-Farber Cancer Institute, Division of Hematology/Oncology, Children's Hospital, Boston, MA; Service de greffe de moelle, Hospital St Louis, AP-HP, Paris, France; Department of Pediatrics, Children's Mercy Hospital, Kansas City, MO; Department of Medicine, University of Florida College of Medicine, Gainesville; International Bone Marrow Transplant Registry, Milwaukee, WI; Department of Psychiatry and Behavioral Science, Northwestern University, Evanston, IL; and Clinical Research Division, Fred Hutchinson Cancer Research Center and University of Washington School of Medicine.

Studies investigating quality of life (QOL) after hematopoietic stem cell transplantation demonstrate the spectrum of QOL outcomes awaiting survivors. Nevertheless, how transplantation physicians interpret and apply QOL information to clinical practice is poorly understood. We conducted a cross-sectional survey of transplantation physicians to address these issues and received 180 (24%) responses from physicians in 29 countries. Seventy-two percent reported that their patients are willing to accept poor QOL for a small chance of cure. Only 28% said that QOL considerations "often" or "almost all the time" enter into patients' decisions about transplantation. This contrasted with physicians' reported attention to QOL in their discussions with patients. Although 53% of physicians reported using QOL results to modify practice, 55% would be more likely to use these data if they were more understandable. To ensure generalizability of the results, a validation sample was randomly selected, and these 85 physicians (response rate, 76%) confirmed the findings of the original survey. Given the extensive data regarding posttransplantation QOL, resources should be devoted to exploring how patients and physicians use these data in clinical care and in devising methods to ensure that QOL results are interpretable and relevant to patients and physicians. (Blood. 2004;104:2194-2200)


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