Closing patient-physician communication gaps during HCT is crucial for patient experiences and outcomes

Although advances in allogeneic hematopoietic cell transplantation (alloHCT) have led to improved patient survival rates, many patients still face significant long-term health challenges, including chronic graft-versus-host disease (cGVHD) and related physical and psychological issues. Studies suggest gaps in communication regarding psychosocial issues, functional status, and overall health maintenance contribute to unmet needs and poor patient experiences. A literature review explored critical areas of patient and physician communication and proposed strategies to improve communication in the alloHCT setting.

Researchers reviewed literature on patient and physician communication in alloHCT. Selected topics were informed by an interdisciplinary research team and community advisory board on cGVHD organized by the European Lymphoma Coalition and the COST Eurograft Consortium.

This review identified significant challenges to patient-physician communication around morbidities experienced by alloHCT survivors due to both patient and physician barriers, including:

• Psychological distress, including anxiety and depression, is experienced by many alloHCT survivors, often exacerbated by cGVHD. However, these issues are rarely proactively addressed by physicians.
• Fatigue affects up to 84% of cGVHD patients but can be overlooked during routine care.
• Cognitive impairments are common but are under-discussed, with patients often normalizing symptoms or not perceiving them as critical.
• Sexual health concerns, reported by 65%-80% of survivors, remain largely unaddressed, with both patients and physicians reluctant to initiate conversations.
• Nonadherence to medications, particularly immunosuppressants, is widespread, yet discussions about adherence are limited.
• Communication about complementary and alternative medicine (CAM) is rare, often due to patient fears of judgment and physician knowledge gaps.

Patient-related communication barriers included reluctance to discuss sensitive issues or fear of burdening physicians. Physician-related barriers included inadequate training in discussing non-medical aspects of patient care (psychological, sexual, etc.) and insufficient knowledge about CAM. 

Understanding areas where communication between patients and physicians can be improved could help improve patient experiences and outcomes. More research is needed in this area, as well as additional education and training to encourage effective communication with patients undergoing alloHCT.

Barata, A et al., published in Transplantation and Cellular Therapy