Development of a Trauma Screening Pathway for Youth and Their Primary Caregiver Undergoing Bone Marrow Transplant: A Feasibility Study

Abstract

Hematopoietic stem cell transplantation (HSCT) is a lifesaving intervention for various hematologic and oncologic diseases that presents significant psychological risks for pediatric patients and their caregivers. Implementation of a longitudinal screening pathway for associated symptoms of post-traumatic stress disorder (PTSD) has been recommended; however, feasibility and utility in directing behavioral health needs remains unclear. Patients’ eligibility for enrollment included scheduled allogeneic or autologous HSCT through our institution’s Center for Cancer and Blood Disorders. Eligible caregivers and patients completed psychometrically validated self-report instruments assessing PTSD symptoms via REDCap pre-transplant, at 30 days, 100 days, 180 days, and 365 days following transplant. Individuals who reported experiencing clinically significant trauma symptoms at any timepoint were referred to a mental health clinician for treatment. If already involved in therapy, session frequency was recommended to increase and trauma-focused interventions were prioritized. Between April 2022 and April 2024, approximately 90% of eligible patients and caregivers consented for study participation (N = 62). Preliminary findings suggest excellent retention and participants represented a diverse sample. Additionally, based on screening results at each timepoint, approximately 70% of our sample was connected to mental health services or offered increased session frequency if already engaged in treatment based on screening results. HSCT reflects a stressful experience for both patients and their caregivers. Systematically screening for PTSD among this population at the time of transplant and throughout the subsequent year was feasible and enabled targeted provision of behavioral health services.

Implications for Impact

It is feasible to screen consistently for symptoms of post-traumatic stress disorder among youth undergoing bone marrow transplant and their primary caregivers throughout the year following transplant. Screening can be incorporated efficiently into routine medical care to avoid adding additional burden on families. Given observed consent and attrition rates, it is clear that traumatic stress screening is acceptable and aligned with family care needs.