Lawyers Partnering with the BMT Team: Impact on Patient Perception of Legal Concerns and Well-Being

Blood and marrow transplant patients (BMT) may experience medical-legal needs such as insurance/disability benefits, will/estate issues, or employment concerns. Patient-families are more often focused on medical issues and legal planning may be deferred or not considered. To test the effects of a Medical-Legal Partnership (MLP) in an adult BMT clinic. Primary objective is to determine if a MLP improves patient perception of legal concerns and well-being. Secondary endpoints include patient stress and patient satisfaction. A two-arm randomized, controlled clinical trial, in which the intervention group participated in a MLP clinic and control group received a community legal resource brochure. Legal issues were identified using the I-Help model and services provided by a non-profit service, Cancer Legal Line. Patients were consented at work-up and randomized using a 2:1 block randomization by age and type of transplant. All subjects completed the same validated questionnaires at first workup and anniversary appointment. The two questionnaires included the “Measure Yourself Concerns and Wellbeing (MYCAW)” and the “Perceived Stress Scale (PSS-10).” At the anniversary visit a Legal Services Satisfaction Survey was also provided. Study enrollment is expected to be completed by January, 2016. As of September, 2015, 65 patients are enrolled, of which 50 records have been quality assured.View Large Image Figure ViewerDownload Hi-res image Download (PPT)Tabled 1DemographicsVariableStandard of CareMLPPvalue[a]N1832Patient AgeMedian (range), (IQR)55 (28-73), (50-64)59 (27-70), (52-64)0.50<6022 (69%)10 (56%)0.35≥6010 (31%)8 (44%)Year of Transplant201411 (61%)16 (50%)0.4520157 (39%)16 (50%)RaceUnknown2 (11%)1 (3%)0.32Caucasian14 (78%)30 (94%)African American1 (6%)1 (3%)Asian1 (6%)Patient Gender: MaleMale9 (50%)13 (41%)0.52DiagnosisAA/FA1 (6%)0.20ALL/AML/MDS4 (22%)9 (27%)CML2 (11%)Non-Hodgkin's/Hodgkins8 (45%)12 (38%)Multiple Myeloma3 (17%)11 (34%)Conditioningmyeloablative11 (61%)26 (81%)0.12RIC7 (39%)6 (19%)Donor TypeRelated4 (22%)5 (16%)0.27Unrelated2 (11%)1 (3%)Autologous10 (56%)21 (66%)UCB-Singles2 (11%)1 (3%)UCB-Doubles4 (13%)[a] P-value for between-treatment comparisons. Continuous variables were analyzed by general Wilcoxon test. Categorical variables were analyzed by chi-square. Open table in a new tab Comparisons across study groups include the general Wilcoxon test and Chi-square test. These tests and descriptive statistics and plots will be used for primary and secondary endpoints. [a] P-value for between-treatment comparisons. Continuous variables were analyzed by general Wilcoxon test. Categorical variables were analyzed by chi-square. BMT patients may benefit from proactively addressing medical-legal issues. Reducing stress of medical-legal issues may potentially help avoid hardships such as job security and financial instability which may impede patients’ ability to support compliance with recommended medical care.