A randomized control trial of stress management for caregivers of stem cell transplant patients: Effect on patient quality of life and caregiver distress.

BACKGROUND: Psychological interventions reduce caregiver distress (CG-distress). Less distress in caregivers may contribute to improved patient quality of life (QoL), but empirical evidence is lacking. Will a caregiver stress management intervention improve patient QoL? METHODS: In this replication study, we randomized 155 allogeneic hematopoietic stem cell transplant (Allo-HSCT) patients and caregivers to PsychoEducation, Paced Respiration, and Relaxation (PEPRR) or enhanced treatment as usual (eTAU). We provided PEPRR over 3 months following transplant. Functional Assessment of Cancer Therapy-Bone Marrow Transplant (FACT-BMT) evaluated patient QoL, and CG-distress was based on depressive, anxious, and stress symptoms. Hierarchical linear models tested intervention, time, and interactions as fixed effects with participant as random effects. RESULTS: Patients whose caregivers received PEPRR did not differ on FACT-BMT between baseline and 6 months (mean = +3.74; 95% CI, -3.54 to 11.02) compared with patients of caregivers in eTAU (mean = +3.16; 95% CI, -2.88 to 9.20) even though CG-distress was decreased by PEPRR (mean = -0.23; 95% CI, -0.448 to -0.010) compared with those receiving eTAU (mean = +0.27; 95% CI, 0.033-0.504) at 6 months. CONCLUSIONS: PEPRR reduced CG-distress without affecting their patient's FACT-BMT score. The FACT-BMT may not have distinguished unique psychological changes associated with their caregiver receiving PEPRR.

The role of physical rehabilitation in stem cell transplantation patients.

The purpose of this paper is to review the evidence for the role of physical rehabilitation in stem cell transplantation patients. We will also review the literature and discuss professional experiences on how rehabilitation can play a role in stem cell transplant care and survivorship. Hematopoietic stem cell transplantation (HCT) is a procedure that has evolved substantially over the years to help treat multiple conditions, particularly hematologic malignancies. HCT can be very stressful on the body and can leave patients weakened and sometimes quite debilitated. Supportive care measures have advanced to improve the quality of life and overall survival of HCT survivors. One key component of improved supportive care is gaining increased attention, and that is physical medicine and rehabilitation. Its role in HCT survivorship care is expanding, and new insight and research within the discipline have focused on fatigue, inflammation, exercise, and the development of structured rehabilitation programs to improve the musculoskeletal sequelae of transplantation. This literature review has demonstrated the utility of physical rehabilitation in HCT, its impact on cancer-related fatigue, and to outline the current state of the literature on these topics. The paper delves into a background of HCT. Cancer-related fatigue in HCT is then discussed and summarized, and the role that exercise plays in modifying such fatigue is outlined. We then outline the models and the impact that physical rehabilitation may play in HCT recipients.

Pain Management for Children during Bone Marrow and Stem Cell Transplantation.

Pain management for children during bone marrow and stem cell transplantation is a significant clinical challenge for the health care team. Pain management strategies vary by institution. This paper reports on the use of a pediatric pain management service and patient- and caregiver-controlled analgesia for children undergoing transplant. This 2-year retrospective chart review examined the pain management practices and outcomes of children undergoing bone marrow and stem cell transplants in a large urban teaching hospital during 2008 and 2009. We concluded that patient- and caregiver-controlled analgesia is a well-tolerated modality for pain control during hospitalization for transplantation at this institution.

[Analysis of the accreditation process JACIE Transplant Program Businco]. / Analisi del processo di Accreditamento JACIE del Programma Trapianti Businco.

INTRODUCTION: The Businco Transplant Program undertook the JACIE standards accreditation process since January 2010. The process is here analyzed by a descriptive-exploratory quantitative study to verify the hypothesis that accreditation according to the standard JACIE improves health professionals performance and organization output. METHODS: An analysis was performed before starting the whole process. An analysis of the planning, programming and implementation of actions was carried out. Data analysis focuses on the organizational and structural changes, training, and preparation of documentation, implementation and verification of objectives achievement. The data refer to the period between January 2010 and October 2012. RESULTS: A dedicated team was set up, an implementation plan and process map was developed. A Quality Management System was also implemented. This included: risk management, audit and quality indicators. CONCLUSIONS: Despite the difficulties the JACIE accreditation process has been useful for integration and professional collaboration. Education of the staff has played a key role in the implementation of the whole system and in particular for the quality management system.

Elevated peri-transplant distress in caregivers of allogeneic blood or marrow transplant patients.

PURPOSE: A full-time 24/7 caregiver is required for 100 days or longer following an allogeneic blood or marrow transplant during which time caregivers have multiple demands. Although distress in caregivers is documented, generalization is limited by small sample sizes, restricted range of assessments, and lack of information as to which caregivers may be more vulnerable to distress. The purpose of this study was to describe the peri-transplant psychological status of a sample of caregivers of allogeneic transplant patients. METHODS: We assessed caregiver mood, stress, burden, and sleep using valid self-report measures in 109 caregivers of allogeneic transplant patients prior to stem cell transplantation. Caregivers' scores were compared with norms or established cutoff scores for behavioral measures. Additionally, demographic characteristics such as age and sex were tested as predictors of distress. RESULTS: Caregivers showed significant levels of anxiety, stress, intrusion and avoidance behaviors, and poor sleep at the start of transplant compared with established norms. Younger caregivers were more distressed than older caregivers. There were no differences in levels of distress between male and female caregivers. CONCLUSION: The peri-transplant period is a time of heightened anxiety and distress for caregivers of allogeneic transplant patients. This study indicates that caregivers would benefit from support programs in the peri-transplant period. Recommendations for types of support that may be helpful to caregivers are provided, but additional research is needed to validate that these programs would help caregivers providing care to patients receiving an allogeneic transplant in the peri-transplant period.

Rehabilitation programme after stem cell transplantation: randomized controlled trial.

AIM: The aim of this study was to compare the effect of two methods of rehabilitation after stem cell transplantation on health and quality of life. BACKGROUND: Stem cell transplantation is routinely used in the treatment of haematological malignancy. However, it is an intensive treatment often associated with deterioration in wellbeing and the need for prolonged recovery. METHODS: During a 14-month data collection period (August 2005 to October 2006), patients who had had a stem cell transplant (n = 58) were randomly allocated to either a healthcare professional-led rehabilitation programme or a self-managed rehabilitation programme. The primary outcome measure, physical functioning as measured by the 36-item Short Form Health Survey, was recorded at baseline and 6 months after randomization. Secondary health and quality of life measures included the seven other dimensions of the 36-item Short Form Health Survey, General Health Questionnaire, Graham and Longman Quality of Life Scale and a Shuttle Walk Test. FINDINGS: There was no difference in change in Short Form 36 physical functioning scores between the two groups at follow-up (mean difference 0.19 points, 95% confidence interval 10.77-11.16). No evidence of a difference between the two modes of rehabilitation was observed for any of the trial outcomes. CONCLUSION: One approach for providing a flexible service may be for staff and individual patients to work together, selecting from a series of specified options a programme with the appropriate content and duration to meet that individual's needs.

Nursing care of patients undergoing allogeneic stem cell transplantation.

Stem cell transplantation (SCT) may be a treatment option for patients who have been diagnosed with a haemato-oncological condition, such as leukaemia, lymphoma or multiple myeloma. SCT is a complex and challenging treatment. In particular, allogeneic transplant significantly increases the risk of developing infections. This article provides an overview of allogeneic SCT, discusses why infections are a major problem and highlights the role nurses play in preventing and managing established infections in this patient group.

Infection prevention strategies in a stem cell transplant unit: impact of change of care in isolation practice and routine use of high dose intravenous immunoglobulins on infectious complications and transplant related mortality.

OBJECTIVE: Nursing in 'live islands' and routine high dose intravenous immunoglobulins after allogeneic hematopoietic stem cell transplantation were abandoned by many teams in view of limited evidence and high costs. METHODS: This retrospective single-center study examines the impact of change from nursing in 'live islands' to care in single rooms (SR) and from high dose to targeted intravenous immunoglobulins (IVIG) on mortality and infection rate of adult patients receiving an allogeneic stem cell or bone marrow transplantation in two steps and three time cohorts (1993-1997, 1997-2000, 2000-2003). RESULTS: Two hundred forty-eight allogeneic hematopoetic stem cell transplantations were performed in 227 patients. Patient characteristics were comparable in the three cohorts for gender, median age, underlying disease, and disease stage, prophylaxis for graft versus host disease (GvHD) and cytomegalovirus constellation. The incidence of infections (78.4%) and infection rates remained stable (rates/1000 days of neutropenia for sepsis 17.61, for pneumonia 6.76). Cumulative incidence of GvHD and transplant-related mortality did not change over time. CONCLUSIONS: Change from nursing in 'live islands' to SR and reduction of high dose to targeted IVIG did not result in increased infection rates or mortality despite an increase in patient age. These results support the current practice.

Acute complications of stem cell transplant.

OBJECTIVES: To provide a comprehensive review of the acute complications that occur during the first 100 days post stem cell transplant (SCT). DATA SOURCES: Research studies, book chapters, websites, and articles. CONCLUSION: Even though the outcomes for SCT continue to improve, the complications seen in the first 100 days post transplant are a significant cause of mortality. Astute nursing assessment with resultant early intervention improves treatment-related mortality. IMPLICATIONS FOR NURSING PRACTICE: Because SCT patients are seen in every oncology care setting, knowledge of these acute complications is essential to helping the nurse care for and educate SCT recipients.

Psychological issues of stem cell transplant.

OBJECTIVES: To address the psychological impact of transplant on quality of life, including physical, psychological, social, and spiritual, for the patient and caregiver, and to discuss the nurse's "emotional labor of caring" and "compassion fatigue" for such an intense vulnerable population. DATA SOURCES: Psychological transplant studies, peer review journals, and textbooks. CONCLUSION: The psychological impact after the experience of transplant can leave an indelible impression on the patient, caregiver, and nurse. IMPLICATIONS FOR NURSING PRACTICE: Suggestions are made for assessment and management of various potential psychological issues for the three mentioned populations. With these issues being better understood, nurses can actively lessen psychological morbidity.

E-Clinic: an innovative approach to complex symptom management for allogeneic blood and stem cell transplant patients.

The allogeneic blood and stem cell program (ABSCP) at Princess Margaret Hospital, Toronto, performs 75 transplants annually. Many patients live greater than 100 kilometres from the centre and require frequent visits to the hospital for posttransplant care. The weekly travel to clinic, combined with complex symptom issues and the overwhelming desire to be cared for in their home community, is a major burden to patients and care providers. Our team of oncology health professionals, led by the nurse practitioner on service, sought to determine whether telehealth videoconferencing would be a viable option as a care delivery model to meet the complex needs of our remote patients and care partners. We introduced telehealth into the ambulatory clinic as a pilot project in early 2005. Patients were selected based upon symptoms, therapeutic plan and geographical remoteness. Patient progress was monitored with a goal of transitioning patients from posttransplant hospital-based care to partnered self-care in their home communities. The purpose of this article is to illustrate the ABSCP telehealth program development using a patient case study, and to detail the clinical process improvements and overall program successes that have led to the integration of telehealth into everyday clinical practice as a viable service delivery option for patient-centred symptom management and treatment compliance with a geographically remote patient population.

Stories and Music for Adolescent/Young Adult Resilience During Transplant Partnerships: Strategies to Support Academic-Clinical Nurse Collaborations in Behavioral Intervention Studies.

Evidence-based nursing is in the forefront of healthcare delivery systems. Federal and state agencies, academic institutions, and healthcare delivery systems recognize the importance of nursing research. This article describes the mechanisms that facilitate nursing partnerships yielding high-level research outcomes in a clinical setting. A phase-II multicenter behavioral intervention study with pediatric stem cell transplant patients was the context of this academic/clinical research partnership. Strategies to develop and maintain this partnership involved a thorough understanding of each nurse's focus and barriers. A variety of communication plans and training events maximized preexisting professional networks. Academic/clinical nurses' discussions identified barriers to the research process, the most significant being role conflict. Communication and validation of benefits to each individual and institution facilitated the research process during challenging times. Establishing strong academic/clinical partnerships should lead to evidence-based research outcomes for the nursing profession, healthcare delivery systems, and patients and families.

Psychological well-being in patients undergoing stem cell transplantation

The aim of the study is to determine the psychological well-being of patients who underwent stem cell transplantation. This cross-sectional study was conducted with 100 patients. Data were collected face-to-face using an introductory information form and the Brief Symptom Inventory.When the results of the patients were examined, the interpersonal sensitivity of the sub-dimensions of the scale was found to be 5.0 ± 4.06, depression 7.60 ± 5.37, and anxiety disorder 7.90 ± 5.34. There was a significant difference between the diagnosistime of the patients and all sub-factors of the scale, except phobic anxiety. It was found that the psychological state of the patients was directly related to the time of first diagnosis. As a result, the importance of following the psychological processof the patients during the treatment process was revealed when planning nursing care.

Measurement of nursing care time of specific interventions on a hematology-oncology unit related to diagnostic categories.

The aim of this study was to develop a tool that can aid nurse managers in planning nurse staffing levels and assessing workload in hematology-oncology wards. A task-oriented method based on a time-and-motion study was used. Three general nursing procedures and 7 specific oncologic and hematologic activities were clocked. It was checked in the charts of the patient, for each day of the admission, how often selected nursing procedures were performed. Then total amount of time needed for each patient was calculated. Data from 29 admissions to the ward were analyzed and divided into 5 categories based upon the treatment performed during that admission. The categories chosen were: autologous stem cell transplantation, allogeneic stem cell transplantation, graft versus host reaction, leukemia treatment, and chemotherapy for solid neoplasm. The results obtained are an estimate of the different daily workload that is required for these categories of patients in selected nursing procedures.

Caring, sharing, and a friendship made for life.

A patient named "Bill" was assigned to my team in the summer of 2012 for an autologous stem cell transplantation for lymphoma. Bill had previous chemotherapy and had attained clinical status eligibility for a transplantation. Although Bill was rather quiet, he had a lot of questions about me, my family, and my travels. In turn, he shared about his work as a veterinarian, his clinic, and his two dogs that went everywhere with him. He also shared his love of the outdoors and traveling, highlighted by a trip on the Amazon River with his father and daughter. I told him that one of my hobbies is making dill pickles. He countered with stories about his bees and honey, and we agreed to share our homemade goods.