A mindfulness-based intervention for caregivers of allogeneic hematopoietic stem cell transplant patients: Pilot results.

Despite high levels of stress, there are few empirically supported stress management interventions for caregivers of allogeneic hematopoietic stem cell transplant (HCT) cancer patients. This study examined the feasibility, acceptability, and various stress-related outcomes from pre- to post-treatment of a pilot, single-arm trial of a 6-week mindfulness-based intervention (FOCUS) for stress management. Caregivers (N = 21; 76% female; mean age = 57.43) were enrolled prior to patient transplant and received FOCUS during the first 90 days post-transplant. Findings indicated that FOCUS was highly feasible and acceptable (e.g., 71% attended at least four of six sessions; 100% reported using the skills learned at follow-up; high treatment engagement). Significant increases in mindfulness, post-traumatic growth, and general mental health were observed, along with significant decreases in negative affect (all ps < .05).

Facilitators and Barriers to Self-Management for Adolescents and Young Adults Following a Hematopoietic Stem Cell Transplant [Formula: see text].

Adolescents and young adults who experience hematopoietic stem cell transplant are at risk for self-management difficulties based on development, psychological comorbidities, and the complexity of the care regimen. Recommendations for practice change were designed to address facilitators and barriers to self-management for adolescents and young adults following hematopoietic stem cell transplant. As part of a grounded theory research study, 30 participants (17 adolescents and young adults and 13 of their caregivers) were individually interviewed and asked about facilitators and barriers to managing care and advice for health care providers. Participant responses were coded into categories, which were named with terms used by the participants. The number of participants who provided data per category was recorded. Self-management is generally characterized only in the ability to follow a prescribed care regimen. Participants indicated mental and emotional experiences as a result of treatment were indistinguishable from self-management activities. Facilitators included having a positive attitude, social support, organization, motivation, and information. Barriers included physical and psychological symptoms, isolation, difficulties with the medication regimen, single parenting, and having a bad attitude. Advice for health care providers included communicating effectively, treating patients holistically, and providing social support.

The Meaning of Disease and Spiritual Responses to Stressors in Adults With Acute Leukemia Undergoing Hematopoietic Stem Cell Transplantation.

BACKGROUND: Some studies have shown that patients with cancer may experience significant spiritual distress as well as spiritual growth, that there is a positive association between spirituality and coping, and that positive religious coping predicts enhanced health outcomes. PURPOSE: This study was designed to help explain how the meaning of disease and spiritual responses to threatening stressors influence the final experiential outcomes of adults with leukemia undergoing hematopoietic stem cell transplantation in Iran. METHODS: This grounded theory study conducted in-depth interviews between 2009 and 2011 on 10 adults in Iran with leukemia undergoing hematopoietic stem cell transplantation. Recorded audio interviews were transcribed verbatim in Persian and coded and analyzed using Corbin and Strauss (2008)'s approach. RESULTS: Main categories that emerged from data included "experiencing the meaning of cancer"; "changing perceptions of death, life and health"; and "moving toward perfection and sublimity." "Finding meaning" was the main concept that defined the final outcome of the experience of participants. CONCLUSIONS/IMPLICATIONS FOR PRACTICE: Understanding the meaning to patients of disease and treatments may help healthcare providers better appreciate the patients' perspective and improve the physician-patient relationship. Nurses are well positioned to play a decisive role in helping patients cope effectively with their treatment process and in helping ensure positive outcomes for treatments through their helping patients find the unique meaning of their experience.

Establishing Feasibility of Early Palliative Care Consultation in Pediatric Hematopoietic Stem Cell Transplantation.

Children and adolescents undergoing hematopoietic stem cell transplantation (HSCT) encounter a number of distressing physical symptoms and existential distress but may not be afforded timely access to palliative care services to help ameliorate the distress. This feasibility study investigated the acceptability and outcomes of early palliative care consultation to promote comfort in this population. A longitudinal, descriptive cohort design examined both provider willingness to refer and willingness of families to receive palliative care interventions as well as satisfaction. Feasibility was demonstrated by 100% referral of eligible patients and 100% of patient and family recruitment (N = 12). Each family received 1 to 3 visits per week (ranging from 15 to 120 minutes) from the palliative care team. Interventions included supportive care counseling and integrative therapies. Families and providers reported high satisfaction with the nurse-led palliative care consultation. Outcomes included improvement or no significant change in comfort across the trajectory of HSCT, from the child and parental perspective. Early integration of palliative care in HSCT is feasible and acceptable to families and clinicians.

Importance of meaning-making for patients undergoing hematopoietic stem cell transplantation.

PURPOSE/OBJECTIVES: The purpose of this integrative literature review of hematopoietic stem cell transplantation (HSCT) for hematologic malignancies was to determine whether meaning-making might be helpful to improve coping and psychological adaptation as patients navigate HSCT. DATA SOURCES: CINAHL®, MEDLINE®, and PsychINFO databases, and ancestry searches. Search terms included bone marrow transplant, hematopoietic stem cell transplant, hematologic malignancy, quality of life, lived experience, psychosocial, psychological, isolation, and social support. DATA SYNTHESIS: Twenty-four research articles published from 1989-2012 were included. Five major themes emerged: (a) lived experience, (b) coping style, (c) quality of life, (d) psychological morbidity, and (e) potential for post-traumatic growth. Meaning-making was a thread that ran through each of the key areas of the HSCT experience. CONCLUSIONS: Physical, psychosocial, and spiritual issues arise during HSCT that are unique among patients diagnosed with cancer. Meaning-making is key to adaptive coping and helps to reduce physical, psychosocial, and spiritual challenges, as well as assists patients in experiencing positive personal growth. Interventions focused on meaning-making should be tested in this population. IMPLICATIONS FOR NURSING: Nurses are positioned to develop and deliver meaning-making interventions for patients undergoing HSCT and to assess patient-oriented outcomes.

Children's lived experiences of hematopoietic stem cell transplantation.

Although hematopoietic stem cell transplantation is a valuable treatment in many life-threatening pediatric disorders, a large number of children who receive hematopoietic stem cell transplantation are faced with a variety of physical and psychological problems throughout this process. In this study, we explored the lived experiences of these children during their treatment to provide a better understanding of their main concerns, emotions, and expectations. The participants were six children, aged between 6 and 17 years, who underwent hematopoietic stem cell transplantation. Data were collected through individual, in-depth, and semistructured interviews. Using interpretive phenomenological analysis, the findings revealed that the children experienced "transplantation rejoicing" in this "difficult passage", which was associated with "deepening of family ties". Awareness of these experiences, feelings, and concerns can help in the development of more professional interventions to provide children with holistic care during their hospitalization.

Prevention of dimethylsulfoxide-related nausea and vomiting by prophylactic administration of ondansetron for patients receiving autologous cryopreserved peripheral blood stem cells.

PURPOSE/OBJECTIVES: To evaluate the effectiveness of ondansetron for the prevention of nausea and vomiting from dimethylsulfoxide (DMSO) during autologous stem cell transplantation (ASCT) infusion. DESIGN: Nonrandomized cohort using historical control. SETTING: Comprehensive cancer center outpatient infusion department. SAMPLE: 50 patients receiving ASCT in the outpatient setting. METHODS: Patients were assessed for nausea and vomiting on their infusion day using the Multinational Association of Supportive Care in Cancer Antiemesis Tool (MAT) at arrival, pre-ASCT infusion, pre-ondansetron administration, prior to the first bag, and after each bag of stem cells. A standard script was used to ensure consistency. Ondansetron, 16 mg IV, was administered 30-90 minutes prior to each ASCT infusion. Number and volume of stem cells bags, as well as infusion rate and emesis episodes, were recorded. Nausea scores and vomiting episodes were compared to historical data. MAIN RESEARCH VARIABLES: Subjectivity of nausea, potential Hawthorne Effect. FINDINGS: Forty-five percent of patients had an MAT score greater than 2 on arrival, decreasing to 18% after receiving ondansetron before the first bag. Twenty-four percent had MAT increases of more than two points by infusion end compared to 58% in the historic control group. Eighteen percent of patients vomited compared to 28% of historic controls. CONCLUSIONS: The administration of 16 mg of IV ondansetron significantly reduced DMSO-related nausea and episodes of vomiting in patients receiving ASCT. IMPLICATIONS FOR NURSING: Prophylactic administration of ondansetron had a positive effect on reducing nausea symptoms and episodes of vomiting during ASCT infusions. These results prompted a change in clinical practice. More research is required to determine whether the inclusion of other antiemetic agents would provide even greater benefit. KNOWLEDGE TRANSLATION: To date, no other published studies have explored the benefits of premedicating patients with ondansetron prior to ASCT infusions. This study is the first to establish efficacy of ondansetron for an unlabeled indication. These results may pave the way for future research in decreasing nausea and vomiting in this setting.

The coping process in adults with acute leukemia undergoing hematopoietic stem cell transplantation.

BACKGROUND: The increasing numbers of leukemia cancer survivors treated with hematopoietic stem cell transplantation (HSCT) face numerous challenges after their transplant procedure. Little information has been published regarding the coping process of this population. Understanding how they cope with this life-threatening disease can assist healthcare professionals to provide holistic care. PURPOSE: This study was designed to elicit the coping process of adults experiencing acute leukemia who underwent HSCT therapy. METHODS: This longitudinal qualitative study and grounded theory took place during 2009-2011. Ten adults with acute leukemia scheduled for HSCT were recruited from Shariati Hospital in Tehran, Iran. A series of pretransplant and posttransplant interviews were held in the hospital's HSCT units. Final interviews took place 2-6 months posttransplant in the hospital's outpatient clinic. RESULTS: The five categories that emerged from the data included perceived threat, suspension between fear and hope, rebirth, contextual factors, and coping strategies. Although patients vacillated within the coping spectrum (i.e., the "buffer zone" between fighting and acquiescing), "finding meaning" was identified as the final outcome of their experience that indicated effective coping. CONCLUSIONS/IMPLICATION FOR PRACTICE: Each patient perceives leukemia and HSCT therapy uniquely. This life-threatening disease can significantly affect patient perception and change patient lives both temporarily and permanently. Nurses can apply effective interventions to help patients cope with their unique situation, find meaning and hope, and allay fear and stress.

Orange interventions for symptoms associated with dimethyl sulfoxide during stem cell reinfusions: a feasibility study.

BACKGROUND: For over 2 decades, oncology nurses at a regional comprehensive cancer center offered sliced oranges to patients during the reinfusion of autologous hematopoietic progenitor cells (HPCs) to relieve symptoms associated with the preservative dimethyl sulfoxide (DMSO). OBJECTIVE: This randomized pilot study examined feasibility and efficacy of sliced orange intervention (OI), orange aromatherapy intervention (OAI), or deep breathing (control) to address unpleasant adverse effects during HPC infusion. METHODS: Orange intervention sniffed or tasted a quartered orange, OAI sniffed orange aromatherapy, and control took deep breaths. Perceived "symptom intensity" for tickle/cough urge, nausea, retching, and perceived "relief" were measured on 0- to 10-point numerical scales. RESULTS: Sixty of 72 eligible patients consented to participate and were randomized to OI (n = 19), OAI (n = 23), or control (n = 18). Study personnel successfully administered study procedures. Over the course of 2 bags of cells infused, the OI group reported significantly greater relief with the intervention (P = .032). Among participants less than 90 kg, OI group reported significantly lower symptom intensity (P = .012). CONCLUSIONS: Results suggest a feasible protocol and potential efficacy of sliced oranges for treating symptoms associated with DMSO-preserved stem cells. Study procedures provide a tested protocol for future studies. Follow-up study is warranted to confirm these findings and evaluate other treatment options. IMPLICATIONS FOR PRACTICE: Oranges offer a simple, noninvasive intervention for relieving symptoms associated with DMSO preservative during autologous HPC infusion.

Glycemic control among older adult hematopoietic cell transplant recipients.

Adults age 55 and older with hematological malignancies who require hematopoietic cell transplantation (HCT) for survival are at risk for a number of nonmalignancy-related, potentially life-threatening outcomes, often due to suboptimal immune function. Evidence is emerging regarding how abnormal glycemic levels-newly termed malglycemia-impair cells of the immune system. Further, older adult HCT recipients appear highly susceptible to malglycemic states, particularly hyperglycemia, due to treatment regimens, nutritional imbalances, states of immobility, and stress, all coupled with the natural aging process. Patients with preexisting diabetes may be at further risk for malglycemic states. The growing number of older adults receiving HCT will substantially increase the likelihood nurses will have to provide care to HCT survivors. Therefore, it is important nurses in all practice settings have an understanding of the short-and long-term effects of glycemic status on immune function.

Effects of a relaxation breathing exercise on anxiety, depression, and leukocyte in hemopoietic stem cell transplantation patients.

This study was performed to investigate the effects of a relaxation breathing exercise on anxiety, depression, and leukocyte count in patients who underwent allogenic hemopoietic stem cell transplantation. Thirty-five patients were randomly selected, with 18 assigned to an exercise group and 17 assigned to a control group. The exercise intervention was applied to the exercise group for 30 minutes every day for 6 weeks. It consisted of physical exercises combined with relaxation breathing. Anxiety was measured by the State-Trait Anxiety Inventory and depression was measured by the Beck Depression Inventory. The total number of leukocytes was calculated from total and differential counts of peripheral white blood cells. The exercise group had a greater decrease in anxiety and depression than did the control group, but the total number of leukocytes did not significantly differ between the two groups. These findings indicate that a relaxation breathing exercise would improve anxiety and depression levels in patients who undergo allogenic hemopoietic stem cell transplantation, but would not affect the number of leukocytes.

Discharge and unscheduled readmissions of adult patients undergoing hematopoietic stem cell transplantation: implications for developing nursing interventions.

PURPOSE/OBJECTIVES: To describe discharge and unscheduled readmission patterns of adult patients undergoing hematopoietic stem cell transplantation (HSCT). To identify implications for nursing practice from survey results and the literature that may improve patient outcomes during and following initial hospital discharge. DESIGN: Retrospective chart review and literature review. SETTING: National Cancer Institute-designated Comprehensive Cancer Center. SAMPLE: 100 adult patients undergoing HSCT in the first six months of 2000. METHODS: Investigator-created retrospective chart-review tool collected data in three areas: demographic, clinical, and readmissions in the first six months after discharge. MAIN RESEARCH VARIABLES: Demographic variables: gender, marital status, age, and diagnosis; clinical variables: remission status at transplant, type of transplant, presence of comorbid or concurrent conditions, number of infections, number of catheter-related infections, number of bacteremic episodes, and psychosocial support; readmission variables: reason for admission, discharge or death data, number of days of each admission, and length of time between discharge to the next admission. FINDINGS: Fifty-one percent had at least one unscheduled readmission, and 80% developed an infection after HSCT. Further analysis comparing autologous to allogeneic transplant recipients indicated that the allogeneic group had a higher number of readmissions, unscheduled readmissions, and infections. Patients who reported an infection within a month prior to HSCT had a 50% mortality rate after transplantation. CONCLUSIONS: Findings indicate that allogeneic transplant recipients are a more vulnerable population in regard to infections and readmissions. Developing and testing nursing interventions surrounding the discharge period are needed next steps in improving care. IMPLICATIONS FOR NURSING: Knowledge of trends in this vulnerable population will guide nursing to plan targeted interventions.

Therapeutic effects of massage therapy and handling touch on caregivers of patients undergoing autologous hematopoietic stem cell transplant.

PURPOSE/OBJECTIVES: To examine the effect of massage therapy and Healing Touch on anxiety, depression, subjective caregiver burden, and fatigue experienced by caregivers of patients undergoing autologous hematopoietic stem cell transplant. DESIGN: Quasi-experimental repeated measures. SETTING: Oncology/hematology outpatient clinic in a large midwestern city. SAMPLE: 36 caregivers: 13 in the control group, 13 in the massage therapy group, and 10 in the Healing Touch group. Average age was 51.5 years; most participants were Caucasian. METHODS: All caregivers completed the Beck Anxiety Inventory, the Center for Epidemiologic Studies Depression Scale, the Subjective Burden Scale, and the Multidimensional Fatigue Inventory-20 before and after treatment consisting of two 30-minute massages or Healing Touch treatments per week for three weeks. Caregivers in the control group received usual nursing care and a 10-minute supportive visit from one of the researchers. MAIN RESEARCH VARIABLES: Anxiety, depression, subjective burden, fatigue, Healing Touch, massage therapy. FINDINGS: Results showed significant declines in anxiety scores, depression, general fatigue, reduced motivation fatigue, and emotional fatigue for individuals in the massage therapy group only. In the Healing Touch group, anxiety and depression scores decreased, and fatigue and subjective burden increased, but these changes did not achieve statistical significance. CONCLUSIONS: Caregivers can benefit from massage therapy in the clinic setting. IMPLICATIONS FOR NURSING: Oncology nurses care for both patients and their caregivers. Although some transplant programs provide services to support lay caregivers, studies indicate that these individuals continue to feel stressed by their situation. Massage might be one intervention that can be used by nurses to decrease feelings of stress in patients' caregivers.