Considerations to optimize vulnerable HCT patients
| Domain impaired . | Intervention . |
|---|---|
| Significant comorbid conditions | Subspecialty consultation and management in context of transplant and disease |
| Impaired function | Structured prehabilitation, encourage and teach patient appropriate activity through transplant. Home assessment aligned with patient limitations |
| Limited social support | Pretransplant family meeting, assign “Team Captain,” and request secondary caregivers |
| Cognitive impairment | Delirium precautions, medication avoidance, and encourage greater presence of family support |
| Depression or anxiety | Recognize problem, cognitive ± medication management, and assess expected adherence post-HCT |
| Weight loss | Exclude concurrent medical problems, add supplements, and develop nutritional plan for transplant |
| Polypharmacy | Hold medications. Re-evaluate day 30 to 100 post-HCT |
| Any impairment | Adjust preparative regimen, donor source, and/or escalate posttransplant follow-up frequency. Assess posttransplant and modify intervention as needed. Enlist caregiver in optimization plan |
| Domain impaired . | Intervention . |
|---|---|
| Significant comorbid conditions | Subspecialty consultation and management in context of transplant and disease |
| Impaired function | Structured prehabilitation, encourage and teach patient appropriate activity through transplant. Home assessment aligned with patient limitations |
| Limited social support | Pretransplant family meeting, assign “Team Captain,” and request secondary caregivers |
| Cognitive impairment | Delirium precautions, medication avoidance, and encourage greater presence of family support |
| Depression or anxiety | Recognize problem, cognitive ± medication management, and assess expected adherence post-HCT |
| Weight loss | Exclude concurrent medical problems, add supplements, and develop nutritional plan for transplant |
| Polypharmacy | Hold medications. Re-evaluate day 30 to 100 post-HCT |
| Any impairment | Adjust preparative regimen, donor source, and/or escalate posttransplant follow-up frequency. Assess posttransplant and modify intervention as needed. Enlist caregiver in optimization plan |