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Visintini C, Lucchetta C, Venturini M, Mansutti I, Chiappinotto S, Patriarca F, Palese A. Perspective on oral medication adherence among patients with acute graft-versus-host disease: a qualitative descriptive study. Support Care Cancer 2024; 32:633. [PMID: 39230629 PMCID: PMC11374915 DOI: 10.1007/s00520-024-08825-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/24/2024] [Accepted: 08/18/2024] [Indexed: 09/05/2024]
Abstract
PURPOSE Despite the importance of adherence to immunosuppressants (IMMs) after an allogeneic haematopoietic stem cell transplant (HSCT) for the treatment of acute graft-versus-host disease (aGvHD), no studies to date have reported the experiences of such patients concerning medication adherence (MA). Therefore, the aim of the study was to explore the perspective on MA to immunosuppressive oral therapy among allogeneic HSCT patients with aGvHD. METHODS A qualitative descriptive study following a reflexive thematic analysis methodological approach was performed involving a purposive sample of 16 patients with aGvHD who were being cared for in the outpatient setting of a bone marrow transplant centre and were willing to participate. Semi-structured audio-recorded interviews were conducted, transcribed verbatim and thematically analysed; member checking was performed. COnsolidated criteria for REporting Qualitative research (COREQ) and the ESPACOMP Medication Adherence Reporting Guideline were followed. RESULTS Participants aged 25-74 years and mostly males (62.5%) were recruited for this study; 56.2% developed grade I, 37.5% grade II and 6.3% grade III aGvHD; 56.2% were receiving treatment with both cyclosporine and prednisone. Patients' perspectives have been summarised into four themes, named: "Transiting from an external obligation to a habit"; "Being in the middle between the negative and positive effects of the IMMs"; "Failure to systematically respect the rules"; and "Adopting personal strategies to become adherent". After difficulties with the perception of feeling obliged, patients became used to adhering to IMMs. Although there were failures in systematically taking the medication correctly and there were episodes of non-adherence, the adoption of personal strategies helped patients to become adherent to their medication schedules. CONCLUSIONS MA in patients with aGvHD is a complex behaviour and is often a challenge. These results can help healthcare professionals and centres to understand how best to design tailored strategies and behavioural interventions to maximise patients' MA to IMMs.
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Affiliation(s)
- Chiara Visintini
- Department of Biomedicine and Prevention, University of Rome Tor Vergata, Montpellier's Street, 1, 00133, Rome, Italy.
- Haematology and Stem Cell Transplantation Unit, Udine University Hospital, Azienda Sanitaria Universitaria Friuli Centrale, Udine, Italy.
| | - Chiara Lucchetta
- Oncology Unit, Udine University Hospital, Azienda Sanitaria Universitaria Friuli Centrale, Udine, Italy
| | | | - Irene Mansutti
- Department of Medicine, University of Udine, Udine, Italy
| | | | - Francesca Patriarca
- Haematology and Stem Cell Transplantation Unit, Udine University Hospital, Azienda Sanitaria Universitaria Friuli Centrale, Udine, Italy
- Department of Medicine, University of Udine, Udine, Italy
| | - Alvisa Palese
- Department of Medicine, University of Udine, Udine, Italy
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Ruan J, Cheng H, Liu Q, Xu F, Kwok WYY, Luo D, Qian Y, Cheung DST, Li H, Yeung WF. Survivorship Experiences of Allogeneic Hematopoietic Stem Cell Transplantation Survivors: A Qualitative Systematic Review. Cancer Nurs 2024:00002820-990000000-00271. [PMID: 39016254 DOI: 10.1097/ncc.0000000000001383] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 07/18/2024]
Abstract
BACKGROUND The number of allogeneic hematopoietic stem cell transplantation (allo-HSCT) survivors is increasing globally. Although qualitative studies in this population are reported, clear understanding of how allo-HSCT survivors experience survivorship is lacking. OBJECTIVE This study aimed to identify, appraise, and synthesize evidence from qualitative research on survivorship experience among allo-HSCT survivors. METHODS A qualitative systematic review was conducted. A literature search of 9 databases and OpenGrey, Google Scholar, and Google was performed from inception to February 2023. Two reviewers independently screened and assessed the eligibility of each study. Descriptive information was extracted from the studies by one reviewer and checked by another. Findings were extracted and analyzed using thematic synthesis. RESULTS Seventeen articles were included. Four themes and 12 subthemes regarding allo-HSCT survivors' experiences emerged: (1) recovery as being a longer process than they thought (influenced by long-term physical symptoms, disturbed by survivorship uncertainty); (2) experiencing a restricted survivorship life (shrunken social world, forced dietary limitations, centered around hospitals); (3) suffering from stigma and discrimination (perceived as a burden, seen differently by others, difficulties establishing and maintaining romantic relationships and marriage, limited opportunities in work); and (4) realizing something positive obtained during survivorship (enriched survivorship self-management skills, enhanced personal growth, developed positive relationships). CONCLUSIONS The findings reveal the challenges, needs, and growth that allo-HSCT survivors experienced during survivorship. Some understudied areas were identified, which warrant further exploration. IMPLICATIONS FOR PRACTICE Targeted survivor-centered care should be provided to allo-HSCT survivors, and interventions to resolve issues experienced during survivorship should be developed.
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Affiliation(s)
- Jiayin Ruan
- Author Affiliations: School of Nursing, The Hong Kong Polytechnic University, Hong Kong Special Administrative Region (Mss Ruan and Liu, Drs Cheng and Yeung, and Mr Kwok); Department of Nursing Science, Faculty of Medicine, University of Malaya, Kuala Lumpur, Malaysia (Ms Xu); School of Nursing, Nanjing University of Chinese Medicine, Nanjing, Jiangsu (Dr Luo); Sir Run Run Shaw Hospital, Zhejiang University School of Medicine, Hangzhou, Zhejiang (Ms Qian); School of Nursing, Li Ka Shing Faculty of Medicine, The University of Hong Kong, Pok Fu Lam, Hong Kong Special Administrative Region (Dr Cheung); and Hematology Department, The First Affiliated Hospital of Zhejiang Chinese Medical University, Hangzhou, Zhejiang (Ms Li), People's Republic of China
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Mazzoleni B, Ferrari G, Savioni F, Gravante F, Lopane D, Dacomi A, Coldani C, Tomaiuolo G, Cattani D, Anastasi G, Mancin S. Non-pharmacological strategies to alleviate dysgeusia in patients undergoing chemotherapy: A systematic review. Eur J Oncol Nurs 2024; 70:102569. [PMID: 38593535 DOI: 10.1016/j.ejon.2024.102569] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/10/2024] [Revised: 03/10/2024] [Accepted: 03/16/2024] [Indexed: 04/11/2024]
Abstract
PURPOSE Dysgeusia is a common side effect in oncology patients, significantly impacting their quality of life. This systematic review aims to evaluate the effectiveness of non-pharmacological strategies in treating dysgeusia in patients undergoing chemotherapy or radiotherapy. METHODS Adhering to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines, we conducted a comprehensive literature search across five databases: PubMed, Embase, Cochrane Library, CINAHL, and the British Nursing Database. We used the Joanna Briggs Institute Critical Appraisal Tools to assess the quality of the included studies. A harvest plot was used to synthesise evidence about the differential effects of population-level interventions. RESULTS Nine studies of non-pharmacological strategies to manage dysgeusia were included. These studies encompassed a variety of interventions, including oral applications and supplements, instrumental techniques, and educational programs. The review identified promising interventions such as cryotherapy and Miraculine supplementation, which showed potential in mitigating taste alterations. Instrumental techniques like photobiomodulation therapy and complementary and integrative medicine approaches, including acupuncture and herbs, were also found to be beneficial. Educational and self-management strategies emerged as effective interventions for empowering patients to manage dysgeusia. Despite the diversity of interventions and the limitations of the included studies, such as small sample sizes and geographical differences, these findings underscore the potential of non-pharmacological strategies in managing dysgeusia. CONCLUSION The results support the integration of these strategies into clinical practice, highlighting the importance of multidisciplinary approaches to improve patient care. Further research should prioritize rigorous studies to enhance evidence and explore long-term effects.
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Affiliation(s)
- Beatrice Mazzoleni
- Department of Biomedical Sciences, Humanitas University, Pieve Emanuele, Milan, Italy
| | - Giulia Ferrari
- Department of Biomedical Sciences, Humanitas University, Pieve Emanuele, Milan, Italy; IRCCS Humanitas Research Hospital, Rozzano, Milan, Italy
| | | | - Francesco Gravante
- Department of Anaesthesiology, Intensive Care Unit, Local Health Autority of Caserta, Caserta, Italy
| | - Diego Lopane
- Department of Biomedical Sciences, Humanitas University, Pieve Emanuele, Milan, Italy; IRCCS Humanitas Research Hospital, Rozzano, Milan, Italy
| | - Alessandra Dacomi
- Department of Biomedical Sciences, Humanitas University, Pieve Emanuele, Milan, Italy; IRCCS Humanitas Research Hospital, Rozzano, Milan, Italy
| | - Chiara Coldani
- Department of Biomedical Sciences, Humanitas University, Pieve Emanuele, Milan, Italy; IRCCS Humanitas Research Hospital, Rozzano, Milan, Italy
| | - Giuseppina Tomaiuolo
- Department of Biomedical Sciences, Humanitas University, Pieve Emanuele, Milan, Italy; IRCCS Humanitas Research Hospital, Rozzano, Milan, Italy
| | - Daniela Cattani
- Department of Biomedical Sciences, Humanitas University, Pieve Emanuele, Milan, Italy; IRCCS Humanitas Research Hospital, Rozzano, Milan, Italy
| | - Giuliano Anastasi
- Department of Trauma, AOU G. Martino University Hospital, Messina, Italy
| | - Stefano Mancin
- Department of Biomedicine and Prevention, University of Rome "Tor Vergata", Rome, Italy.
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Chen Y, Fang Y, Liu M, Yao R, Wan J. Taste alterations in patients following hematopoietic stem cell transplantation: A qualitative study. Asia Pac J Oncol Nurs 2023; 10:100311. [PMID: 38033392 PMCID: PMC10685015 DOI: 10.1016/j.apjon.2023.100311] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/11/2023] [Accepted: 09/24/2023] [Indexed: 12/02/2023] Open
Abstract
Objective This study aims to explore the experiences and consequences of taste alterations in patients undergoing HSCT, how they respond to these changes, and the factors that influence their responses. Methods In this descriptive qualitative study, face-to-face semi-structured individual interviews were conducted with 31 patients undergoing HSCT in a comprehensive hospital in Hubei, China. The interview data were transcribed and analyzed using Colaizzi's seven-step analysis. The Symptom Management Theory was applied to design the study and identify key themes. Results Three key themes were identified from the theory: (1) the complexity and diversity of taste experiences; (2) coping strategies; and (3) the multifaceted challenges of coping. Taste alterations in HSCT patients were characterized by diversity and dynamism. Patients employed three distinct coping styles in response to taste alterations: active coping, reluctant submission, and passive coping. These coping styles were influenced by various factors, including the specific treatment modalities of HSCT, individual patient characteristics, and the healthcare environment. Conclusions The experience of taste alterations among HSCT patients is intricate and varied, and the importance of addressing this symptom can easily be underestimated. Management of taste alterations is influenced by multiple factors. Nursing staff should give careful attention to taste alterations in HSCT survivors, enhance their expertise in managing taste alterations, provide robust health education, conduct regular screening and assessments, and formulate individualized intervention plans to assist patients in actively and effectively managing taste alterations.
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Affiliation(s)
- Yuanyuan Chen
- Cancer Center, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
| | - Yun Fang
- Department of Hematology, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
| | - Minjie Liu
- Department of Hematology, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
| | - Ruishan Yao
- Cancer Center, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
| | - Jia Wan
- Cancer Center, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
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Food preferences and aversions of patients undergoing chemotherapy, radiotherapy and/or hematopoietic stem cell transplantation. Clin Nutr ESPEN 2021; 44:331-336. [PMID: 34330486 DOI: 10.1016/j.clnesp.2021.05.023] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/27/2021] [Revised: 05/16/2021] [Accepted: 05/23/2021] [Indexed: 01/06/2023]
Abstract
BACKGROUND & AIMS This longitudinal, qualitative, descriptive, and exploratory study aimed to identify and understand the food preferences and aversions arising from hematopoietic stem cell transplantation (HSCT), chemotherapy, and/or radiotherapy treatment. METHODS An open and individual interview was carried out with patients diagnosed with hematological diseases or cancer, submitted to HSCT, chemotherapy, and/or radiotherapy treatment. The participants answered the following questions: "Have you experienced any changes in taste since the beginning of radiotherapy/chemotherapy?"; "Have you experienced any strange taste in your mouth, aversion or preference for a certain food that did not exist before the beginning of radiotherapy/chemotherapy?" The software IRAMUTEQ (R Interface for Multidimensional Analysis of Texts and Questionnaires) version 0.7 alpha 2 was used for textual analysis, with similarity analysis and word cloud. RESULTS One hundred and forty six patients were included in the study, 50% (n = 73) female and 73% (n = 50) elderly. The main words reported by the participants in regards to food aversions were "meat", "beef" and "chicken", which are related to dysphagia. Regarding food preferences, the most mentioned words were "fruits", "juices" and "soups", whose consumption was associated with an improvement in gastrointestinal symptoms, especially nausea. CONCLUSION Adjustments in the diet plan based on this information can contribute to a better acceptance of the diet, and clinical and nutritional prognosis.
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Patients' experience of haemorrhagic cystitis after Haematopoietic Stem Cell Transplantation: Findings from a phenomenological study. Eur J Oncol Nurs 2021; 51:101926. [PMID: 33677414 DOI: 10.1016/j.ejon.2021.101926] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/14/2020] [Revised: 02/13/2021] [Accepted: 02/14/2021] [Indexed: 11/21/2022]
Abstract
PURPOSE Haemorrhagic cystitis (HC) is a severe complication of haematopoietic stem cell transplantation (HSCT), which significantly affects patients' quality of life. However, no qualitative studies have described to date the experience of patients who have developed this complication. Therefore, the aim of this interpretative phenomenological study performed on 2019 was to explore the experience of patients who developed HC after HSCT. METHOD A purposeful sample of nine patients who had experienced at least one episode of HC after the HSCT were approached. The audio-recorded interviews were transcribed verbatim and then analysed according to Giorgi's method. Member checking of the findings was also performed. RESULTS The experience of the participants with HC after HSCT has been summarised around three main themes: "Being alerted", "It has arrived" and "It has been overcome." Patients reported to have been informed regarding the HC; after the first devastating symptoms, they reported fear and in searching for causes and strategies to alleviate the problem, which seemed to be never resolved. Patients' experience with HC is complex and experienced dramatically due to the pain and the discomforting consequences of the treatments received; they develop a sense of exhaustion that can further increase both their physical and emotional burden. The process of recovery from the huge impact, required time over the end of the HC symptoms. CONCLUSIONS Patients' experience of HC is complex, and varies according to the various phases of the complication. HC creates an increased physical and psychological stresses that demand additional coping strategies: therefore, the emotional support of patients is crucial. Moreover, strategies used autonomously by patients to alleviate symptoms are at merit of consideration in future studies.
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BUENO MDC, JOCHIMS AMK, BEHLING EB. Food intake of children and adolescents submitted to allogeneic hematopoietic stem cells transplantation. REV NUTR 2021. [DOI: 10.1590/1678-9865202134e200266] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
Abstract
ABSTRACT Objective Describe the dietary intake of children and adolescents submitted to allogeneic hematopoietic stem cell transplantation. Methods Data from 0 to 19-year-old patients’ medical records who were submitted to the procedure from January 2012 to September 2017 were used. These medical records provided anthropometric, food intake control and symptoms data for three moments: three days before infusion (M1), the infusion day (M2), and 25 days after the cell infusion (M3). This study was approved by the Ethics in Research Committee (17-0267). Results The patients presented weight loss (p>0.001) and a decrease in body mass index (p>0.001) in M1 versus M2 and M3. The means of calorie intake (p=0.031), protein (p=0.006), lipid (p=0.017), dietary fiber (p=0.035), calcium (p=0.005), iron (p=0.012), and sodium (p=0.022) had a reduction from M1 to M2 and an increase from M2 to M3. There was a decrease in mean intake of carbohydrates and calories per kilo from M1 to M2 and an increase from M2 to M3. The nutritional status was related to temperature above 37ºC (p<0.001) and to mucositis (p=0.001), in M1 and M2. There was a correlation of dietary intake with the presence of temperature above 37ºC (p=0.019) in M2 and M3. Conclusion Reduced intake and worsening of the patients’ previous nutritional status appear to interfere with allogeneic hematopoietic stem cell transplantation and its complications, such as the presence of temperature above 37ºC and mucositis.
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