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Gray TF, Do KM, Amonoo HL, Sullivan L, Kelkar AH, Pirl WF, Hammer MJ, Tulsky JA, El-Jawahri A, Cutler CS, Partridge AH. Family Caregiver Experiences in the Inpatient and Outpatient Reduced-Intensity Conditioning Allogeneic Hematopoietic Cell Transplantation Settings: A Qualitative Study. Transplant Cell Ther 2024; 30:610.e1-610.e16. [PMID: 37783339 DOI: 10.1016/j.jtct.2023.09.023] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/07/2023] [Revised: 09/21/2023] [Accepted: 09/24/2023] [Indexed: 10/04/2023]
Abstract
Caregivers (ie, family and friends) are essential in providing care and support for patients undergoing hematopoietic cell transplantation (HCT) and throughout their recovery. Traditionally delivered in the hospital, HCT is being increasingly provided in the outpatient setting, potentially heightening the burden on caregivers. Extensive work has examined the inpatient HCT caregiving experience, yet little is known about how caregiver experiences may differ based on whether the HCT was delivered on an inpatient or outpatient basis, particularly during the acute recovery period post-HCT. This study explored the similarities and differences in caregiver experiences in the inpatient and outpatient settings during the early recovery from reduced-intensity conditioning (RIC) allogeneic HCT. We conducted semistructured interviews (n = 15) with caregivers of adults undergoing RIC allogeneic HCT as either an inpatient (n = 7) or an outpatient (n = 8). We recruited caregivers using purposeful criterion sampling, based on the HCT setting, until thematic saturation occurred. Interview recordings were transcribed and coded through thematic analysis using Dedoose v.9.0. The study analysis was guided by the transactional model of stress and coping and the model of adaptation of family caregivers during the acute phase of BMT. Three themes emerged to describe similar experiences for HCT caregivers regardless of setting: (1) caregivers reported feeling like they were a necessary yet invisible part of the care team; (2) caregivers described learning to adapt to changing situations and varying patient needs; and (3) caregivers recounted how the uncertainty following HCT felt like existing between life and death while also maintaining a sense of gratitude and hope for the future. Caregivers also reported distinct experiences based on the transplantation setting and 4 themes emerged: (1) disrupted routines: inpatient caregivers reported disrupted routines when caring for the HCT recipient while simultaneously trying to manage non-caregiving responsibilities at home and work, and outpatient caregivers reported having to establish new routines that included frequent clinic visits with the patient while altering or pausing home and work responsibilities; (2) timing of caregiver involvement: inpatient caregivers felt more involved in care after the patient was discharged from the HCT hospitalization, whereas outpatient caregivers were already providing the majority of care earlier in the post-transplantation period; (3) fear of missing vital information: inpatient caregivers worried about missing vital information about the patient's care and progress if not physically present in the hospital, whereas outpatient caregivers feared overlooking vital information that may warrant contacting the care team as they monitored the patient at home; and (4) perceived adequacy of resources to meet psychosocial and practical needs: inpatient caregivers reported having adequate access to resources (ie, hospital-based services), whereas outpatient caregivers felt they had more limited access and needed to be resourceful in seeking out assistance. Inpatient and outpatient HCT caregivers described both similar and distinct experiences during the acute recovery period post-HCT. Specific interventions should address caregiver psychosocial needs (ie, distress, illness uncertainty, communication, and coping) and practical needs (ie, community resource referral, preparedness for home-based caregiving, and transplantation education) of HCT caregivers based on setting.
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Affiliation(s)
- Tamryn F Gray
- Department of Psychosocial Oncology and Palliative Care, Dana-Farber Cancer Institute, Boston, Massachusetts; Division of Population Sciences, Department of Medical Oncology, Dana-Farber Cancer Institute, Boston, Massachusetts; Division of Stem Cell Transplantation and Cellular Therapies, Dana-Farber Cancer Institute, Boston, Massachusetts; Harvard Medical School, Boston, Massachusetts; Phyllis F. Cantor Center for Research in Nursing and Patient Care Services, Dana-Farber Cancer, Boston, Massachusetts; Division of Palliative Medicine, Brigham and Women's Hospital, Boston, Massachusetts; Cancer Outcomes Research and Education Program, Massachusetts General Hospital Cancer Center, Boston, Massachusetts.
| | - Khuyen M Do
- Department of Psychosocial Oncology and Palliative Care, Dana-Farber Cancer Institute, Boston, Massachusetts
| | - Hermioni L Amonoo
- Department of Psychosocial Oncology and Palliative Care, Dana-Farber Cancer Institute, Boston, Massachusetts; Harvard Medical School, Boston, Massachusetts; Cancer Outcomes Research and Education Program, Massachusetts General Hospital Cancer Center, Boston, Massachusetts; Department of Psychiatry, Brigham and Women's Hospital, Boston, Massachusetts
| | - Lauren Sullivan
- Division of Stem Cell Transplantation and Cellular Therapies, Dana-Farber Cancer Institute, Boston, Massachusetts
| | - Amar H Kelkar
- Division of Stem Cell Transplantation and Cellular Therapies, Dana-Farber Cancer Institute, Boston, Massachusetts; Harvard Medical School, Boston, Massachusetts
| | - William F Pirl
- Department of Psychosocial Oncology and Palliative Care, Dana-Farber Cancer Institute, Boston, Massachusetts; Harvard Medical School, Boston, Massachusetts; Department of Psychiatry, Brigham and Women's Hospital, Boston, Massachusetts
| | - Marilyn J Hammer
- Division of Population Sciences, Department of Medical Oncology, Dana-Farber Cancer Institute, Boston, Massachusetts; Harvard Medical School, Boston, Massachusetts; Phyllis F. Cantor Center for Research in Nursing and Patient Care Services, Dana-Farber Cancer, Boston, Massachusetts
| | - James A Tulsky
- Department of Psychosocial Oncology and Palliative Care, Dana-Farber Cancer Institute, Boston, Massachusetts; Harvard Medical School, Boston, Massachusetts; Division of Palliative Medicine, Brigham and Women's Hospital, Boston, Massachusetts
| | - Areej El-Jawahri
- Harvard Medical School, Boston, Massachusetts; Cancer Outcomes Research and Education Program, Massachusetts General Hospital Cancer Center, Boston, Massachusetts; Divison of Hematology and Oncology, Department of Medicine, Massachusetts General Hospital, Boston, Massachusetts
| | - Corey S Cutler
- Division of Population Sciences, Department of Medical Oncology, Dana-Farber Cancer Institute, Boston, Massachusetts; Division of Stem Cell Transplantation and Cellular Therapies, Dana-Farber Cancer Institute, Boston, Massachusetts; Harvard Medical School, Boston, Massachusetts; Division of Hematologic Malignancies, Dana-Farber Cancer Institute, Boston, Massachusetts
| | - Ann H Partridge
- Division of Population Sciences, Department of Medical Oncology, Dana-Farber Cancer Institute, Boston, Massachusetts; Harvard Medical School, Boston, Massachusetts
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Langer SL, Joseph RP, Mistretta EG, Tao C, Porter LS, Campos AS, Khera N. Family-Focused Facilitated Fitness: Feasibility and Acceptability of a Couple-Based Physical Activity Intervention for Hematopoietic Cell Transplant Recipients and Their Caregiving Partners. Transplant Cell Ther 2024; 30:450.e1-450.e17. [PMID: 38244696 DOI: 10.1016/j.jtct.2024.01.066] [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: 06/30/2023] [Revised: 01/12/2024] [Accepted: 01/14/2024] [Indexed: 01/22/2024]
Abstract
Reductions in physical activity (PA) are common among patients following hematopoietic cell transplantation, and a risk factor for poor physical functioning. PA among spouses/cohabiting partners, who frequently serve as the patient's primary caregiver, may also be reduced due to caregiving demands and limited bandwidth for self-care. In addition, the patient-caregiver relationship can be compromised, and communication patterns disrupted. All PA interventions in the hematopoietic cell transplantation setting have focused entirely on patients, ignoring an opportunity to synergistically engage and benefit the caregiver as well. We sought to test feasibility and acceptability of a couple-based intervention entitled Family-Focused Facilitated Fitness (FFFF), designed to improve PA as assessed by daily step counts among both patients undergoing hematopoietic cell transplantation and their caregivers. Guided by interdependence and communal coping perspectives, FFFF is an 8-week, remotely-delivered intervention that provides training in communication skills and joint problem-solving to help patients and caregivers support one another in PA. Participants are also given a Fitbit to track their steps and weekly individualized step prescription based on the 75th percentile ranked value of their last 7 recorded daily step counts. A priori benchmarks for feasibility and acceptability in this single-arm pilot were as follows: 50% of eligible couples would agree to participate, 70% of couples would attend all 8 sessions, 80% of participants would provide valid Fitbit wear data 4/7 days/ week, and among sessions reviewed for treatment fidelity, 85% of treatment protocol elements would be covered. Couples were recruited prior to transplant. Among 26 couples approached and deemed eligible, 17 enrolled (65% agreement) and completed baseline assessment. Three couples later withdrew after transplantation but prior to receiving the intervention, resulting in 14 couples commencing the intervention, on average 21 days post-transplant. Four couples subsequently discontinued due to medical complications (n = 3) or caregiver schedule (n = 1). Among the 10 couples who completed the intervention, the percentage of participants meeting our benchmark of valid Fitbit wear at least 4 days per week was 85% in week 1, 90% in weeks 2 to 7, and 80% in week 8. Treatment fidelity was 95% on average across 24 sessions reviewed (3 cases). Treatment satisfaction scores were uniformly high across multiple dimensions, with all means above 4 on the 1 to 5 scale. Daily step counts among those attending all 8 intervention sessions increased from 2249 ± 302 steps/day in week 1 to 4975 ± 1377 steps/day in week 8 among patients, and from 8676 ± 3760 steps/day in week 1 to 9838 ± 3723 steps/day in week 8 among caregivers. Qualitative feedback indicated perceived mental and physical health benefits of the program. Participants also offered suggestions for adaptations to accommodate medical setbacks and constraints. All a priori feasibility benchmarks were met or exceeded. Results offer promise for utility of the program to engage and leverage patient-caregiver dyads to increase PA following transplant. An investigation using a randomized controlled design will be necessary to adequately examine change over time relative to control and its possible impact on clinical and patient-reported outcomes.
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Affiliation(s)
- Shelby L Langer
- Center for Health Promotion and Disease Prevention, Edson College of Nursing and Health Innovation, Arizona State University, Phoenix, AZ.
| | - Rodney P Joseph
- Center for Health Promotion and Disease Prevention, Edson College of Nursing and Health Innovation, Arizona State University, Phoenix, AZ
| | - Erin G Mistretta
- Department of Rehabilitation Medicine, University of Washington, Seattle, WA
| | - Chun Tao
- Mayo Clinic Arizona, Phoenix, AZ
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Edward JS, Rayens MK, McLouth LE, Eisele LP, Scales J, Williams LB, Hildebrandt G. A dyadic analysis of financial toxicity and health-related quality of life among bone marrow transplant patients and their caregivers. Psychooncology 2024; 33:e6303. [PMID: 38342820 PMCID: PMC10947586 DOI: 10.1002/pon.6303] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/10/2023] [Revised: 01/11/2024] [Accepted: 02/01/2024] [Indexed: 02/13/2024]
Abstract
OBJECTIVE Relatively few dyad-based studies have evaluated the shared psychosocial and financial toxicity (FT) experiences of hematologic patients and their caregivers, especially those undergoing bone marrow transplantations (BMTs). This study evaluated the association of FT with health-related quality of life (QOL) among BMT patient-caregiver dyads. METHODS Survey and electronic health record data were collected between April 2021 and January 2022 from BMT patients and their caregivers pre- (T1) and post-intervention (T2). Thirty-four patient-caregiver dyads completed surveys; all dyads included a patient experiencing elevated T1 FT. The effect of the total FT score (i.e., the combination of psychological response, coping behaviors, and material conditions domain scores) on physical health, mental health, anxiety, depression and distress scores was evaluated using Actor-Partner Interdependence Modeling (APIM). RESULTS Patients and caregivers who reported lower total FT scores had better physical and mental health, and lower anxiety, depressive symptoms, distress (APIM actor effects). None of the partner effects were significant in the APIM models. Other model findings indicated that compared with caregivers, patients had lower reported physical health; mental health scores were higher, on average, for all participants at the T2 compared with T1; and members of dyads whose caregiver took time off work reported better physical health and lower depressive symptoms and distress than those whose caregiver did not. CONCLUSIONS Our study addresses a significant gap in dyad-based cancer FT studies; the findings underscore the need for additional research to help develop tailored dyad-level FT interventions for improving health-related QOL among BMT patients.
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Affiliation(s)
- Jean S Edward
- College of Nursing, University of Kentucky, Lexington, Kentucky, USA
| | - Mary Kay Rayens
- College of Nursing, University of Kentucky, Lexington, Kentucky, USA
| | - Laurie E McLouth
- Department of Behavioral Health, College of Medicine, University of Kentucky, Lexington, Kentucky, USA
| | - Lori P Eisele
- College of Nursing, University of Kentucky, Lexington, Kentucky, USA
| | - Joan Scales
- Psycho-oncology Program, Markey Cancer Center, University of Kentucky, Lexington, Kentucky, USA
| | | | - Gerhard Hildebrandt
- Ellis Fischel Cancer Center, Missouri University Health Care, Columbia, Missouri, USA
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Wall SA, Olin R, Bhatt V, Chhabra S, Munshi P, Hacker E, Hashmi S, Hassel H, Howard D, Jayani R, Lin R, McCurdy S, Mishra A, Murthy H, Popat U, Wood W, Rosko AE, Artz A. The Transplantation Ecosystem: A New Concept to Improve Access and Outcomes for Older Allogeneic Hematopoietic Cell Transplantation Patients. Transplant Cell Ther 2023; 29:632.e1-632.e10. [PMID: 37137442 DOI: 10.1016/j.jtct.2023.04.020] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/16/2023] [Revised: 04/24/2023] [Accepted: 04/26/2023] [Indexed: 05/05/2023]
Abstract
Allogeneic hematopoietic cell transplantation (HCT) is increasingly offered to older adults with hematologic malignancies, even though nonrelapse mortality remains a major concern in older patients owing to more comorbidities and greater frailty compared with their younger counterparts. The importance of patient fitness, a well-matched donor, and disease control to the success of allogeneic HCT have been well documented; however, these factors fail to account for the impact of the complex transplantation ecosystem (TE) that older adult HCT candidates must navigate. We propose a definition of the TE modeled after the social determinants of health. Furthermore, we outline a research agenda aimed at increasing understanding of the roles of individual social determinants of transplantation health in the larger ecosystem and how they may benefit or harm older adult HCT candidates. Herein we define the TE and its individual tenets, the social determinants of transplantation health. We review the available literature while incorporating the expertise of the membership of the American Society for Transplantation and Cellular Therapy (ASTCT) Special Interest Group for Aging. The membership of the ASTCT Special Interest Group for Aging identify knowledge gaps and strategies to address them for each of the described social determinants of transplantation health. The ecosystem is an essential but underappreciated pillar for transplant access and success. We put forth this novel research agenda seeking to gain a better understanding of the complexity of HCT in older adults and develop strategies to improve access to HCT, survival, and quality of life.
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Affiliation(s)
- Sarah A Wall
- Division of Hematology, Ohio State University, Columbus, OH.
| | - Rebecca Olin
- Division of Hematology & Oncology, University of California San Francisco, San Francisco, CA
| | - Vijaya Bhatt
- Division of Hematology & Oncology, University of Nebraska Medical Center, Omaha, NE
| | - Saurabh Chhabra
- Division of Hematology & Oncology, Medical College of Wisconsin, Milwaukee, WI
| | - Pashna Munshi
- Division of Oncology, Georgetown University Medical Center, Washington, DC
| | - Eileen Hacker
- Department of Nursing, The University of Texas MD Anderson Cancer Center, Houston, TX
| | - Shahrukh Hashmi
- Division of Hematology, Mayo Clinic Minnesota, Rochester, MN
| | - Hailey Hassel
- National Marrow Donor Program/Be The Match, Minneapolis, MN
| | - Dianna Howard
- Division of Hematology & Oncology, Wake Forest University School of Medicine, Winston-Salem, NC
| | - Reena Jayani
- Division of Hematology & Oncology, Vanderbilt University Medical Center, Nashville, TN
| | - Richard Lin
- Division of Hematologic Malignancies, Memorial Sloan Kettering Cancer Center, New York, NY
| | - Shannon McCurdy
- Division of Hematology & Oncology, University of Pennsylvania, Philadelphia, PA
| | - Asmita Mishra
- Department of Malignant Hematology, Moffitt Cancer Center, Tampa, FL
| | - Hemant Murthy
- Division of Hematology & Oncology, Mayo Clinic, Jacksonville, FL
| | - Uday Popat
- Department of Nursing, The University of Texas MD Anderson Cancer Center, Houston, TX
| | - William Wood
- Division of Hematology, The University of North Carolina at Chapel Hill, Chapel Hill, NC
| | - Ashley E Rosko
- Division of Hematology, Ohio State University, Columbus, OH
| | - Andrew Artz
- Division of Hematology & Hematopoietic Cell Transplantation, City of Hope Comprehensive Cancer Center, Duarte, CA
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F H, V G, A M, T B, SW C. Positive psychology interventions for family caregivers coping with cancer: Who will use them? Health Psychol Open 2023; 10:20551029231224358. [PMID: 38152307 PMCID: PMC10752074 DOI: 10.1177/20551029231224358] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/29/2023] Open
Abstract
Background Positive psychology-based (PPB) activities have been under-researched in cancer caregiving. Objective This study investigated caregiver: (1) attitudes toward using PPB activities while caregiving; and (2) characteristics associated with these attitudes. Methods Secondary analyses of a cross-sectional survey were conducted in a national caregiver sample of hematopoietic cell transplant (HCT) patients. Survey items assessed caregivers' likelihood of engaging in six PPB activities. Hierarchical regression was performed and potential predictors of PPB activity use (e.g., technology familiarity, coping style, caregiving duration) were examined. Results Most of the N = 948 respondents were White (78.9%), female (65.5%), married (86.7%), employed (78.4%), and college-educated (79.8%). Caregivers favorably disposed to positive activities were younger and female, provided care for 6-12 months and >40 h/week, and used coping styles involving religion and social support. Conclusions Our findings provide guidance for development and testing of PPB activities for cancer caregivers.
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Affiliation(s)
- Hoodin F
- Department of Psychiatry, Michigan Medicine, University of Michigan, Ann Arbor, MI, USA
| | - Gupta V
- Department of Computer Science & Data Science, School of Applied Computational Sciences, Meharry Medical College, Nashville, TN, USA
| | - Mazzoli A
- Oakland UniversityWilliam Beaumont School of Medicine, Auburn Hills, MI, USA
| | - Braun T
- Department of Biostatistics, School of Public Health, University of Michigan, Ann Arbor, MI, USA
| | - Choi SW
- Department of Pediatrics, Michigan Medicine, University of Michigan, Ann Arbor, MI, USA
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6
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Cusatis R, Litovich C, Spellecy R, Liang A, D'Souza A. Navigating the perils and pitfalls throughout the consent process in hematopoietic cell transplantation. Blood Rev 2023; 59:101037. [PMID: 36577602 PMCID: PMC10548336 DOI: 10.1016/j.blre.2022.101037] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/18/2022] [Revised: 11/29/2022] [Accepted: 12/15/2022] [Indexed: 12/25/2022]
Abstract
Hematopoietic cell transplantation (HCT) is a complex treatment used in malignancies and some non-malignant diseases. The informed consent process for HCT can also be complex due to patient- and process-related barriers. The informed consent process needs to be a dynamic and ongoing process, not simply a checklist. As a result of the realities of HCT, we highlight some potential pitfalls to the informed consent process including uncertainty, sociocultural and communication barriers, and decisional regret. The purpose of this comprehensive review is to highlight unique situations which can result in failure of the informed consent process. We also offer potential solutions to these pitfalls, primarily making the informed consent more patient focused through dynamic and continuous processes to mitigate decisional regret.
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Affiliation(s)
- Rachel Cusatis
- Center for International Blood & Marrow Transplant Research, Department of Medicine, Medical College of Wisconsin, United States of America.
| | - Carlos Litovich
- Center for International Blood & Marrow Transplant Research, Department of Medicine, Medical College of Wisconsin, United States of America
| | - Ryan Spellecy
- Center for Bioethics and Medical Humanities, Medical College of Wisconsin, United States of America
| | - Andrew Liang
- Student-centered Program to Advance Research in Cancer Careers (SPARCC) Program, Department of Obstetrics & Gynecology, Medical College of Wisconsin, United States of America; Molecular Cell Developmental Biology, University of California, Los Angeles, United States of America
| | - Anita D'Souza
- Division of Hematology/Oncology, Department of Medicine, Medical College of Wisconsin, United States of America.
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Applebaum AJ, Sannes T, Mitchell HR, McAndrew NS, Wiener L, Knight JM, Nelson AJ, Gray TF, Fank PM, Lahijani SC, Pozo-Kaderman C, Rueda-Lara M, Miran DM, Landau H, Amonoo HL. Fit for Duty: Lessons Learned from Outpatient and Homebound Hematopoietic Cell Transplantation to Prepare Family Caregivers for Home-Based Care. Transplant Cell Ther 2023; 29:143-150. [PMID: 36572386 PMCID: PMC9780643 DOI: 10.1016/j.jtct.2022.12.014] [Citation(s) in RCA: 10] [Impact Index Per Article: 10.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/30/2022] [Revised: 12/15/2022] [Accepted: 12/16/2022] [Indexed: 12/24/2022]
Abstract
In the past decade, the demand for home-based care has been amplified by the Coronavirus disease 2019 pandemic. Home-based care has significant benefits for patients, their families, and healthcare systems, but it relies on the often-invisible workforce of family and friend caregivers who shoulder essential health care responsibilities, frequently with inadequate training and support. Hematopoietic cell transplantation (HCT), a potentially curative but intensive treatment for many patients with blood disorders, is being increasingly offered in home-based care settings and necessitates the involvement of family caregivers for significant patient care responsibilities. However, guidelines for supporting and preparing HCT caregivers to effectively care for their loved ones at home have not yet been established. Here, informed by the literature and our collective experience as clinicians and researchers who care for diverse patients with hematologic malignancies undergoing HCT, we provide considerations and recommendations to better support and prepare family caregivers in home-based HCT and, by extension, family caregivers supporting patients with other serious illnesses at home. We suggest tangible ways to screen family caregivers for distress and care delivery challenges, educate and train them to prepare for their caregiving role, and create an infrastructure of support for family caregivers within this emerging care delivery model.
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Affiliation(s)
- A J Applebaum
- Department of Psychiatry and Behavioral Sciences, Memorial Sloan Kettering Cancer Center, New York, New York.
| | - T Sannes
- Department of Psychosocial Oncology and Palliative Care, Dana-Farber Cancer Institute, Harvard Medical School, Boston, Massachusetts
| | - H R Mitchell
- Ferkauf Graduate School of Psychology, Yeshiva University, Bronx, New York
| | - N S McAndrew
- College of Nursing, University of Wisconsin-Milwaukee, Milwaukee, WI, USA; Froedtert & the Medical College of Wisconsin, Froedtert Hospital, Patient Care Research, Milwaukee, Wisconsin
| | - L Wiener
- Pediatric Oncology Branch, National Cancer Institute, Center for Cancer Research, National Institutes of Health, Bethesda, MD
| | - J M Knight
- Departments of Psychiatry, Medicine, and Microbiology & Immunology, Medical College of Wisconsin, Milwaukee, Wisconsin
| | - A J Nelson
- Department of Psychiatry, Harvard Medical School/Massachusetts General Hospital, Boston, Massachusetts
| | - T F Gray
- Department of Psychosocial Oncology and Palliative Care, Dana-Farber Cancer Institute, Harvard Medical School, Boston, Massachusetts
| | - P M Fank
- Department of Psychiatry and Behavioral Sciences, Rush University Medical Center, Chicago, Illinois
| | - S C Lahijani
- Department of Psychiatry & Behavioral Sciences, Division of Medical Psychiatry, Stanford University School of Medicine, Palo Alto, California
| | - C Pozo-Kaderman
- Department of Psychosocial Oncology and Palliative Care, Dana-Farber Cancer Institute, Harvard Medical School, Boston, Massachusetts
| | - M Rueda-Lara
- University of Miami/Leonard Miller School of Medicine, Department of Psychiatry and Behavioral Sciences, Sylvester Comprehensive Cancer Center, Miami, Florida
| | - D M Miran
- Department of Psychosocial Oncology and Palliative Care, Dana-Farber Cancer Institute, Department of Psychiatry, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts
| | - H Landau
- Adult Bone Marrow Transplant Service, Memorial Sloan Kettering Cancer Center, New York, New York
| | - H L Amonoo
- Department of Psychosocial Oncology and Palliative Care, Dana-Farber Cancer Institute, Department of Psychiatry, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts
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Abstract
The informal caregiver experience has surged as a research topic in health care, including in nursing. However, the "informal" language is controversial, lacking conceptual clarity. Without a common understanding of who an "informal caregiver" may be, nurses may fail to consistently identify informal caregivers requiring support. Therefore, a concept analysis of "informal caregiver" was conducted on the basis of a sample of 20% of relevant nursing literature. The analysis of the attributes, antecedents, consequences, and contexts associated with "informal caregiver" offers a foundational guide for the ongoing development of nurses' understanding of the informal caregiver role.
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9
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Tan KR, Fredrickson B, Santos H, Wood W, Schwartz TA, Mayer DK. A Visual Case-Oriented Analysis of Stress-Related Symptoms in Caregivers of Allogeneic Bone Marrow Transplantation Recipients. Oncol Nurs Forum 2022; 49:541-551. [PMID: 36413733 PMCID: PMC10431954 DOI: 10.1188/22.onf.541-551] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Abstract
OBJECTIVES To describe trends in caregiver stress and stress-related symptoms (anxiety, depression, fatigue, and sleep disturbance) across 12 weeks post-transplantation. SAMPLE & SETTING 11 caregivers were recruited from a National Cancer Institute-designated comprehensive cancer center's bone marrow transplantation (BMT) outpatient clinic in the southeastern United States. METHODS & VARIABLES A visual case-oriented analysis was conducted on data from 11 caregivers' weekly self-reported data to identify trends after allogeneic BMT. RESULTS The authors identified three primary trends as follows: U-shaped (highest symptoms at start of transplantation and end of study; n = 3), negatively sloped (highest symptoms at beginning of transplantation and decreasing over time; n = 2), and V-shaped predischarge (highest symptoms at start of transplantation and right before discharge home; n = 4). Two caregivers did not have postdischarge data because of patient death prior to study completion. IMPLICATIONS FOR NURSING Caregivers may benefit from additional support to manage their stress-related symptoms at the start of transplantation and just before discharge.
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Affiliation(s)
- Kelly R. Tan
- Lineberger Comprehensive Cancer Center, University of North Carolina At Chapel Hill, Chapel Hill, NC, USA
| | - Barbara Fredrickson
- Department of Psychology & Neuroscience, University of North Carolina At Chapel Hill, Chapel Hill, NC, USA
| | - Hudson Santos
- School of Nursing, University of North Carolina At Chapel Hill, Chapel Hill, NC, USA
| | - William Wood
- Lineberger Comprehensive Cancer Center, University of North Carolina At Chapel Hill, Chapel Hill, NC, USA
- School of Medicine, University of North Carolina At Chapel Hill, Chapel Hill, NC, USA
| | - Todd A. Schwartz
- School of Public Health, Department of Biostatistics, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA
| | - Deborah K. Mayer
- Lineberger Comprehensive Cancer Center, University of North Carolina At Chapel Hill, Chapel Hill, NC, USA
- School of Nursing, University of North Carolina At Chapel Hill, Chapel Hill, NC, USA
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10
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Yang MJ, Yepez VV, Brandon KO, Reblin M, Pidala J, Jim HSL, Meyer JS, Gore LR, Khera N, Lau P, Sauls RM, Jones SR, Vinci C. A mindfulness-based stress management program for caregivers of allogeneic hematopoietic stem cell transplant (HCT) patients: Protocol for a randomized controlled trial. PLoS One 2022; 17:e0266316. [PMID: 35363799 PMCID: PMC8975158 DOI: 10.1371/journal.pone.0266316] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/02/2022] [Accepted: 03/08/2022] [Indexed: 01/05/2023] Open
Abstract
Objectives Caregivers of allogeneic hematopoietic stem cell transplant (HCT) cancer patients experience high caregiver burden and carry a significant amount of responsibility. Mindfulness has the potential to lessen caregiver burden by aiding in stress management. To date, no studies have examined the efficacy of mindfulness in reducing caregiver burden in this population. Based on our pilot study demonstrating initial feasibility and acceptability of FOCUS (Focusing On mindfulness for Caregivers Under Stress), this 3-arm randomized controlled trial aims to examine the efficacy of a 6-week mindfulness-based stress management program for allogeneic HCT caregivers. Hypotheses include that the FOCUS condition will have lower post-treatment caregiver burden and that patients of these caregivers will have better patient health outcomes compared to other treatment conditions. Method Eligible caregivers will be randomly assigned to one of three treatment conditions: FOCUS, Healthy Living (HL; active control), and Enhanced Care (EC; usual care). Caregivers in FOCUS and HL will participate in 6-week weekly individual treatment sessions and will be sent brief daily momentary interventions/messages. Caregivers in all conditions will complete daily diaries over the course of treatment. Patients of enrolled caregivers will be enrolled for assessments only. Participants will complete assessments at baseline, end of treatment, 2- and 6-months post-treatment. Biomarker data will be collected via hair cortisol concentrations from caregivers at baseline and 6 months post-treatment. Results Recruitment is ongoing. Conclusions The data collected from this study will provide evidence on the efficacy of mindfulness in alleviating HCT caregiver stress and impacting patient health outcomes. Trial registration The current study is registered in clinicaltrials.gov (NCT05078229); see https://clinicaltrials.gov/ct2/show/NCT05078229?term=christine+vinci&draw=2&rank=1.
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Affiliation(s)
- Min-Jeong Yang
- Department of Health Outcomes and Behavior, Moffitt Cancer Center, Tampa, Florida, United States of America
| | - Valerie V. Yepez
- Department of Health Outcomes and Behavior, Moffitt Cancer Center, Tampa, Florida, United States of America
| | - Karen O. Brandon
- Department of Health Outcomes and Behavior, Moffitt Cancer Center, Tampa, Florida, United States of America
- Department of Psychology, University of South Florida, Tampa, Florida, United States of America
| | - Maija Reblin
- College of Medicine, University of Vermont, Burlington, Vermont, United States of America
| | - Joseph Pidala
- Department of Blood & Marrow Transplantation, Moffitt Cancer Center, Tampa, Florida, United States of America
| | - Heather S. L. Jim
- Department of Health Outcomes and Behavior, Moffitt Cancer Center, Tampa, Florida, United States of America
| | - Jerrold S. Meyer
- Department of Psychological & Brain Sciences, University of Massachusetts, Amherst, Massachusetts, United States of America
| | - L. Robert Gore
- Department of Health Outcomes and Behavior, Moffitt Cancer Center, Tampa, Florida, United States of America
- Department of Biostatistics and Bioinformatics, Moffitt Cancer Center, Tampa, Florida, United States of America
| | - Nandita Khera
- Division of Hematology and Oncology, Mayo Clinic, Phoenix, Arizona, United States of America
- College of Medicine, Mayo Clinic, Phoenix, Arizona, United States of America
| | - Penny Lau
- Department of Social Work, Moffitt Cancer Center, Tampa, Florida, United States of America
| | - Rachel M. Sauls
- Department of Health Outcomes and Behavior, Moffitt Cancer Center, Tampa, Florida, United States of America
| | - Sarah R. Jones
- Department of Health Outcomes and Behavior, Moffitt Cancer Center, Tampa, Florida, United States of America
| | - Christine Vinci
- Department of Health Outcomes and Behavior, Moffitt Cancer Center, Tampa, Florida, United States of America
- Department of Psychology, University of South Florida, Tampa, Florida, United States of America
- * E-mail:
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11
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Pasyar N, Rambod M, Zahedi F, Ramzi M. Pain, Fatigue, Nausea, and Vomiting as the Predictors of Anxiety in Patients Undergoing Hematopoietic Stem Cell Transplantation: A Prospective Cohort Study. Support Care Cancer 2022; 30:5871-5879. [PMID: 35359172 PMCID: PMC8970971 DOI: 10.1007/s00520-022-06997-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/20/2021] [Accepted: 03/18/2022] [Indexed: 11/17/2022]
Abstract
The primary outcome was to assess the correlation between anxiety and pain, fatigue, nausea, and vomiting. The secondary outcome was to determine the predictive roles of pain, fatigue, nausea, and vomiting in anxiety among patients undergoing Hematopoietic Stem Cell Transplantation (HSCT). The present prospective cohort study was conducted on 200 patients treated by HSCT referred to the centers affiliated to Shiraz University of Medical Sciences. The data were collected using Spielberger Anxiety Questionnaire, Numerical Pain Scale, Brief Fatigue Inventory, and Rhodes Nausea and Vomiting Index. The data were analyzed using Spearman’s test and multiple regression analysis. The means of state anxiety, trait anxiety, pain, fatigue, and nausea, vomiting, and retching were 41.67 (SD = 9.71), 43.78 (SD = 9.00), 3.79 (SD = 2.79), 4.23 (SD = 2.48), and 6.31 (SD = 7.53), respectively. The results showed that the participants with higher pain and fatigue scores had higher anxiety levels. Those with more nausea and vomiting had higher anxiety levels, as well. This indicated that fatigue, pain, severity and frequency of nausea, and type of HSCT were the predictors of trait anxiety. The results also showed the predictor role of pain, fatigue, and type of HSCT in state anxiety. The findings revealed a correlation between anxiety and pain, fatigue, nausea, and vomiting among the HSCT patients. The results also showed fatigue and pain as the predictors of anxiety among these patients. Yet, future studies are recommended to determine the other factors contributing to anxiety amongst HSCT patients.
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Affiliation(s)
- Nilofar Pasyar
- Community Based Psychiatric Care Research Center, School of Nursing and Midwifery, Shiraz University of Medical Sciences, Zand St., Nemazee Sq., 7193613119, Shiraz, Iran
| | - Masoume Rambod
- Community Based Psychiatric Care Research Center, School of Nursing and Midwifery, Shiraz University of Medical Sciences, Zand St., Nemazee Sq., 7193613119, Shiraz, Iran.
| | - Fatemeh Zahedi
- Student Research Committee of Shiraz University of Medical Sciences, Shiraz, Iran
| | - Mani Ramzi
- Hematology Research Center, Department of Hematology and Medical Oncology, Shiraz University of Medical Sciences, Shiraz, Iran
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12
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Nakajima S, Kamibeppu K. Quality of life and informational needs for allogeneic hematopoietic stem cell transplant among patients and their caregivers visiting long-term follow-up clinic. BLOOD CELL THERAPY 2022; 5:35-44. [PMID: 36710950 PMCID: PMC9870686 DOI: 10.31547/bct-2021-005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 06/02/2021] [Accepted: 11/02/2021] [Indexed: 02/01/2023]
Abstract
Purpose To examine the relationship between health-related quality of life (HRQOL) and fulfillment of informational needs among patients for allogeneic hematopoietic stem cell transplant (HSCT) and caregivers who visit long-term follow-up (LTFU) clinics within 1.5 years of post-HSCT. Methods We conducted a cross-sectional survey at two university hospitals in Japan between May and December 2018 using self-administered questionnaires and medical records. Based on previous research and patient interviews, informational needs of patients and caregivers were categorized into general information, post-discharge treatments, side effects and complications, self-care, psychosocial problems, and social resources. The HRQOL of patients and caregivers was measured using the Japanese Functional Assessment of Cancer Therapy-Bone Marrow Transplant (for patients) and Caregiver Quality of Life Index-Cancer (for caregivers). In addition, the pooled-regression actor-partner interdependence model approach was employed to analyze the relationships using R ver.3.6.0. Results A total of 16 patients and 14 caregivers were analyzed. The mean total score of the FACT-BMT was 91.0, and the mean total score of the Caregiver Quality of Life Index-Cancer was 88.2. For both patients and caregivers, fulfillment of informational needs regarding side effects and complications (estimates = 0.55, t (16) = 4.88, P < 0.001) and self-care (estimates = 0.73, t (13) = 5.02, P < 0.001) exerted actor effects on their HRQOL, whereas fulfillment of informational needs regarding psychosocial problems (estimates = 0.35, t (13) = 2.90, P = 0.012) exerted a partner effect on the mutual HRQOL. Conclusions Multidimensional physio-psychosocial approaches toward patients and their caregivers are important to enhance their HRQOL during the acute phase after HSCT. Detailed overviews of and methods to cope with patients' psychosocial issues should be provided before discharge, especially for caregivers unable to visit the LTFU clinics.
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Affiliation(s)
- Shohei Nakajima
- Department of Family Nursing, The University of Tokyo, Japan,Global Nursing Research Center, The University of Tokyo, Japan,Department of Nursing, The University of Tokyo Hospital, Japan
| | - Kiyoko Kamibeppu
- Department of Family Nursing, The University of Tokyo, Japan,Global Nursing Research Center, The University of Tokyo, Japan,QOL Research Center for Children and Family, Japan
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13
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Experiences and Needs of Caregivers of Adult Patients With Hematologic Malignancies During Treatment. Cancer Nurs 2022; 45:E801-E809. [DOI: 10.1097/ncc.0000000000001054] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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14
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Lehto RH, Wyatt G, Sender J, Miller SE. An Evaluation of Natural Environment Interventions for Informal Cancer Caregivers in the Community. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2021; 18:ijerph182111124. [PMID: 34769643 PMCID: PMC8583496 DOI: 10.3390/ijerph182111124] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 10/11/2021] [Accepted: 10/19/2021] [Indexed: 11/17/2022]
Abstract
Home-based informal caregiving by friends and family members of patients with cancer is be-coming increasingly common globally with rates continuing to rise. Such caregiving is often emo-tionally and cognitively demanding, resulting in mental exhaustion and high perceived burden. Support for caregivers may be fostered by engagement with the natural environment. Interaction with nature is associated with mental health benefits such as stress reduction and improved well-being. The purpose of this paper was to evaluate the state of the science regarding the use of nat-ural environment interventions to support caregivers of cancer patients in the community. A comprehensive scoping review using the Arksey and O’Malley framework and the Preferred Re-porting Items for Systematic Reviews and Meta-analyses assessed natural environment therapies and mental health outcomes among cancer caregivers. Databases searched included CINAHL, PubMed, Scopus, Cochrane, and Alt HealthWatch. Findings recovered a total of five studies over a 10-year period that met criteria, demonstrating a lack of empirical evidence addressing this po-tential resource to support caregivers. Often, study appraisal was not on nature exposure, but ra-ther other aspects of the projects such as program evaluation, exercise, or complementary thera-pies. Both qualitative and quantitative designs were used but sample sizes were small. Caregivers experienced beneficial results across the various studies and future work could enhance these findings.
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Affiliation(s)
- Rebecca H. Lehto
- College of Nursing, Michigan State University, East Lansing, MI 48824, USA; (G.W.); (J.S.)
- Correspondence:
| | - Gwen Wyatt
- College of Nursing, Michigan State University, East Lansing, MI 48824, USA; (G.W.); (J.S.)
| | - Jessica Sender
- College of Nursing, Michigan State University, East Lansing, MI 48824, USA; (G.W.); (J.S.)
| | - Sara E. Miller
- Department of Human Development and Family Studies, Pennsylvania State University, State College, PA 16802, USA;
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15
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Natvig C, Mikulich-Gilbertson SK, Laudenslager ML, Bradley CJ. Association between employment status change and depression and anxiety in allogeneic stem cell transplant caregivers. J Cancer Surviv 2021; 16:1090-1095. [PMID: 34417708 DOI: 10.1007/s11764-021-01099-3] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/13/2021] [Accepted: 08/11/2021] [Indexed: 10/20/2022]
Abstract
PURPOSE Allogeneic hematopoietic stem cell transplantation (Allo-HSCT) is a demanding treatment that requires caregiver support during the first 100 days post-transplant. Little is known about the association between caregivers' employment changes and their well-being during this lengthy and challenging time when caregivers may be balancing work with caregiving responsibilities. METHODS We used data from employed caregivers of Allo-HSCT patients who participated in two randomized clinical trials (N = 187) of an intervention for caregivers. Caregiver depression and anxiety were assessed using the Center for Epidemiologic Studies Depression and the Spielberger State-Trait Anxiety Inventory. ANCOVA was used to measure the associations between reducing work with depression and anxiety. Caregiver's demographics and baseline employment status were controlled in the analysis along with the patient's transplant conditioning intensity. RESULTS Approximately 45% of caregivers reduced hours worked following the resumption of their caregiving duties. These caregivers, on average, had 3.49 points higher depression scores than caregivers who did not report a reduction in work (p < 0.01). Similarly, these caregivers also reported, on average, 3.56 higher anxiety scores (p < 0.10). CONCLUSIONS Caregivers who reduced hours worked while caregiving reported greater distress. The underlying cause of this distress deserves further investigation. IMPLICATIONS FOR CANCER SURVIVORS Caregivers of patients diagnosed with cancer may experience considerable stress related to work discontinuation and caregiving. Interventions are needed to support caregivers who are trying to balance work and caregiving responsibilities.
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Affiliation(s)
- Crystal Natvig
- Department of Psychiatry, School of Medicine, University of Colorado Denver Anschutz Medical Campus, Aurora, CO, USA.
| | - Susan K Mikulich-Gilbertson
- Department of Psychiatry, School of Medicine, University of Colorado Denver Anschutz Medical Campus, Aurora, CO, USA
| | - Mark L Laudenslager
- Department of Psychiatry, School of Medicine, University of Colorado Denver Anschutz Medical Campus, Aurora, CO, USA
| | - Cathy J Bradley
- Department of Health Systems, Management, and Policy, School of Public Health, University of Colorado Denver Anschutz Medical Campus, Aurora, CO, USA
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16
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Warlick ED, Ustun C, Andreescu A, Bonagura AF, Brunner A, Chandra AB, Foran JM, Juckett MB, Kindwall-Keller TL, Klimek VM, Pease DF, Steensma DP, Waldman BM, Horowitz MM, Burns LJ, Khera N. Blood and Marrow Transplant Clinical Trials Network Study 1102 heralds a new era in hematopoietic cell transplantation in high-risk myelodysplastic syndromes: Challenges and opportunities in implementation. Cancer 2021; 127:4339-4347. [PMID: 34375439 DOI: 10.1002/cncr.33826] [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: 04/12/2021] [Revised: 06/16/2021] [Accepted: 06/22/2021] [Indexed: 12/16/2022]
Abstract
LAY SUMMARY People who have advanced myelodysplastic syndromes (MDS) may live longer if they get a bone marrow transplant (BMT) instead of other therapies. However, only 15% of people with MDS actually get BMT. Experts say community physicians and transplant physicians should team up with insurance companies and patient advocacy groups to 1) spread this news about lifesaving advances in BMT, 2) ensure that everyone can afford health care, 3) provide emotional support for patients and families, 4) help patients and families get transportation and housing if they need to travel for transplant, and 5) improve care for people of under-represented racial and ethnic backgrounds.
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Affiliation(s)
- Erica D Warlick
- Division of Hematology, Oncology, and Transplantation, University of Minnesota, Minneapolis, Minnesota
| | | | - Astrid Andreescu
- Northern Light Eastern Maine Medical Center, Lafayette Family Cancer Institute, Bangor, Maine
| | | | | | | | - James M Foran
- Mayo Clinic Cancer Center, Mayo Clinic, Jacksonville, Florida
| | - Mark B Juckett
- School of Medicine and Public Health, University of Wisconsin, Madison, Wisconsin
| | | | | | | | | | - Bryce M Waldman
- Center for International Blood and Marrow Transplant, Milwaukee, Wisconsin
| | - Mary M Horowitz
- Center for International Blood and Marrow Transplant, Milwaukee, Wisconsin.,Medical College of Wisconsin, Milwaukee, Wisconsin
| | - Linda J Burns
- Center for International Blood and Marrow Transplant, Milwaukee, Wisconsin
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17
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Understanding the Process and Challenges for Return-to-Work Post-Hematopoietic Cell Transplantation from a Musculoskeletal Perspective: A Narrative Review. Occup Ther Int 2021; 2021:5568513. [PMID: 34316293 PMCID: PMC8277503 DOI: 10.1155/2021/5568513] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/26/2021] [Revised: 05/02/2021] [Accepted: 06/18/2021] [Indexed: 12/20/2022] Open
Abstract
The current paper seeks to inform healthcare professionals on how adapting various components of return to work (RTW) programs that are already in use by other musculoskeletal rehabilitation settings can help optimize return to work process for patients with or without musculoskeletal manifestations, posthematopoietic cell transplantation. Since there is no universally agreed RTW structure for hematopoietic cell transplant patients, a narrative approach has been taken utilizing evidence from the existing musculoskeletal return to work assessment publications to help draw parallel for the hematopoietic cell transplant patients. Databases were searched including PUBMED, CINHAL, AMED, SCOPUS, and Cochrane using keywords RTW, functional restoration program, hematopoietic cell transplant, bone marrow transplant, stem cell transplant, and musculoskeletal functional assessment. The authors have managed to outline and propose a structured RTW assessment and monitoring program which can aid in getting patients back to employment by utilizing the functional capacity and job evaluation to help hematopoietic cell transplantation patients reintegrate socially. Patients undergoing hematopoietic cell transplant require additional support and a robust assessment system to allow safe RTW. The proposed model of RTW assessment can prove to be beneficial in helping patients return to work safely. Clinical Significance. To acknowledge the individuality in functional limitation is important in determining not only the rehab needs but also the RTW capabilities. The proposed RTW plan not only promotes an individualized approach to patients but also provides a structure for return to work assessments for hematopoietic cell transplantation patients, thus, eliminating the need for guess work by healthcare professionals. In line with the International Classification of Functioning, Disability, and Health (ICF) recommendations, a RTW assessment combined with a job evaluation helps healthcare professionals and stakeholders to understand the unique challenges and strengths of a patient and thereby design an individualized therapy approach.
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18
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Atout M, Tarawneh FS, Al-Kharabsheh A. Challenges Faced by Mothers Caring for Children with Leukaemia During COVID-19 Pandemic: A Qualitative Study. J Pediatr Nurs 2021; 58:e74-e80. [PMID: 33526289 PMCID: PMC8815105 DOI: 10.1016/j.pedn.2021.01.009] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/19/2020] [Revised: 01/16/2021] [Accepted: 01/16/2021] [Indexed: 11/17/2022]
Abstract
PURPOSE This study aimed to investigate the experiences of parents who care for children diagnosed with leukaemia. This paper is focused solely on reporting the interview findings from participating mothers regarding the challenges of caring for children with leukaemia in the context of the COVID-19. DESIGN AND METHODS The study took place in a Jordanian hospital where a descriptive qualitative design approach was applied on one oncology floor and an oncology clinic. Semi-structured interviews were conducted with mothers of children aged 1-12 with acute lymphoblastic leukaemia (ALL). Inductive thematic analysis approach was undertaken. Written consent was obtained from all participants. RESULTS Fifteen interviews were conducted with fifteen mothers. Four major themes reflect the different challenges parents and children face during the COVID-19 pandemic: children refusing to wear masks, social isolation, family relationship and financial concerns. CONCLUSIONS The findings of the current study present important data for health care professionals to help them understand the challenges faced by parents and children with leukaemia, especially during the COVID-19 pandemic. PRACTICAL IMPLICATIONS This study suggests activating emotional support teams in hospitals. These teams can actively help mothers express their concerns and worries which might otherwise foster self-blame, guilt and isolation.
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Affiliation(s)
- Maha Atout
- School of Nursing, Philadelphia University, Jordan.
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19
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Gupta V, Raj M, Hoodin F, Yahng L, Braun T, Choi SW. Electronic Health Record Portal Use by Family Caregivers of Patients Undergoing Hematopoietic Cell Transplantation: United States National Survey Study. JMIR Cancer 2021; 7:e26509. [PMID: 33687332 PMCID: PMC8086639 DOI: 10.2196/26509] [Citation(s) in RCA: 12] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/14/2020] [Revised: 01/18/2021] [Accepted: 01/21/2021] [Indexed: 12/27/2022] Open
Abstract
Background As family caregivers of patients undergoing hematopoietic cell transplantation have multifaceted caregiving responsibilities (such as medical, household, financial) of long duration, they also have multiple physical, social, psychological, and informational needs. Objective This study explored the prevalence of electronic health record patient portal use by family caregivers for managing both their own and their hematopoietic cell transplantation care recipient’s health, as well as potential factors associated with portal use. Methods An electronic caregiver health survey, first developed via cognitive interviewing methods of hematopoietic cell transplantation caregivers, was distributed nationally (in the United States) by patient advocacy organizations to family caregivers of hematopoietic cell transplantation patients. It was used to assess self-reported caregiver demographics, caregiving characteristics, depression and anxiety with the Patient Health Questionnaire–4, coping with the Brief COPE, and caregiver portal use to manage care recipient’s and their own health. Results We found that 77% of respondents (720/937) accessed electronic health record patient portals for their care recipients, themselves, or both. Multivariate models indicated use of care recipient electronic health record portals by caregivers was more likely with young, White, married, low-income caregivers caring for a parent, residing with the care recipient, and experiencing more caregiver depression. Caregiver use of their own electronic health record portal was more likely with young, White, high-income caregivers caring for a parent and experiencing chronic medical conditions of their own. Partially due to multicollinearity, anxiety and coping did not contribute independently to this model. Conclusions Findings from the survey could open avenues for future research into caregiver use of technology for informational support or intervention, including wearables and mobile health. International Registered Report Identifier (IRRID) RR2-10.2196/4918
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Affiliation(s)
- Vibhuti Gupta
- Department of Pediatrics, University of Michigan, Ann Arbor, MI, United States
| | - Minakshi Raj
- Department of Kinesiology and Community Health, University of Illinois at Urbana Champaign, Champaign, IL, United States
| | - Flora Hoodin
- Department of Psychology, Eastern Michigan University, Ypsilanti, MI, United States.,Department of Psychiatry, University of Michigan, Ann Arbor, MI, United States
| | - Lilian Yahng
- Center for Survey Research, Indiana University, Bloomington, IN, United States
| | - Thomas Braun
- Department of Biostatistics, School of Public Health, University of Michigan, Ann Arbor, MI, United States
| | - Sung Won Choi
- Department of Pediatrics, University of Michigan, Ann Arbor, MI, United States
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20
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Tan KR, Santacroce SJ, Wood WA, Mayer DK, Santos H, Mucha PJ, Schwartz TA, Fredrickson BL. Positive psychological states and stress responses in caregivers of adults receiving an allogeneic bone marrow transplant: A study protocol. J Adv Nurs 2021; 77:2073-2084. [PMID: 33460207 DOI: 10.1111/jan.14742] [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: 11/17/2020] [Accepted: 12/10/2020] [Indexed: 12/24/2022]
Abstract
AIMS This protocol directs a study that aims to: (a) describe the caregiver's experience over 8-12 weeks after an index adult patient's allogeneic bone marrow transplant (BMT) for advanced cancer using a case-oriented approach and mixed methods, with qualitative methods in the foreground; and (b) explore networks of relationships among psycho-neurological symptoms, positive psychological states and caregiver health. DESIGN Case-oriented longitudinal design using multiple data types and analytic approaches. METHODS Data will be collected from 10-12 caregivers. The sample will be recruited from a large public hospital in the southeastern United States using maximum variation sampling (e.g., caregiver race/ethnicity, relationship to patient, age, education, and number of caregiving roles). Participants will be asked to complete weekly surveys, have their blood drawn bi-weekly and participate in an interview each month during the study period (~100 days). Aim 1 analysis will include directed content analysis and case-oriented visual analysis. Aim 2 analysis will include symptom network estimation of psycho-neurological symptoms, positive psychological states, and caregiver health. Institutional review board approval was obtained August 2018. DISCUSSION Results will provide an in-depth description of caregivers' experiences in the 100 days after BMT. Findings will inform generation of hypotheses and identification of targets for interventions to improve caregiver's experiences after BMT. IMPACT This in-depth multi-method longitudinal study to describe caregivers of adult patients receiving an allogeneic BMT is an essential step in understanding caregivers' complex responses to chronic stress and the role of positive psychological states. The results from this study will inform future research on chronic stress processes, intense caregiving, and intervention development.
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Affiliation(s)
- Kelly R Tan
- School of Nursing, University of North Carolina, Chapel Hill, North Carolina, USA
| | - Sheila J Santacroce
- School of Nursing, University of North Carolina, Chapel Hill, North Carolina, USA.,Lineberger Comprehensive Cancer Center, University of North Carolina, Chapel Hill, North Carolina, USA
| | - William A Wood
- Lineberger Comprehensive Cancer Center, University of North Carolina, Chapel Hill, North Carolina, USA.,Division of Hematology/Oncology, Department of Medicine, University of North Carolina, Chapel Hill, North Carolina, USA
| | - Deborah K Mayer
- School of Nursing, University of North Carolina, Chapel Hill, North Carolina, USA.,Lineberger Comprehensive Cancer Center, University of North Carolina, Chapel Hill, North Carolina, USA
| | - Hudson Santos
- School of Nursing, University of North Carolina, Chapel Hill, North Carolina, USA
| | - Peter J Mucha
- Department of Mathematics and Applied Physical Sciences, University of North Carolina, Chapel Hill, North Carolina, USA
| | - Todd A Schwartz
- School of Nursing, University of North Carolina, Chapel Hill, North Carolina, USA.,Department of Biostatistics, University of North Carolina, Chapel Hill, North Carolina, USA
| | - Barbara L Fredrickson
- Lineberger Comprehensive Cancer Center, University of North Carolina, Chapel Hill, North Carolina, USA.,Department Of Psychology and Neuroscience, University of North Carolina, Chapel Hill, North Carolina, USA
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21
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Martino M, Pitino A, Tripepi G, Paviglianiti A, Russo L, Cusumano G, Rossetti A, Provenzano PF, Porto G, Meliambro N, Gallo S, Porcino D, Romeo V, Gangemi T, D'Arrigo G, Imbalzano L, Console G, Gori M. The Burden in Caregivers of Multiple Myeloma Patients Undergoing Outpatient Autologous Stem-Cell Transplantation Compared to Inpatient Transplantation. CLINICAL LYMPHOMA MYELOMA & LEUKEMIA 2020; 21:e402-e409. [PMID: 33288484 DOI: 10.1016/j.clml.2020.11.011] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/05/2020] [Accepted: 11/15/2020] [Indexed: 11/27/2022]
Abstract
BACKGROUND The application of different models of autologous stem-cell transplantation (ASCT) in multiple myeloma has demonstrated the feasibility and safety of outpatient-based programs of care. Although several systematic reviews have evaluated the burden of caregivers, only a few studies have included outpatient ASCT. PATIENTS AND METHODS The feelings of lack of family support, daily activities, and general health were compared between caregivers of 2 groups of patients with multiple myeloma who underwent inpatient (n = 71) or outpatient (n = 25) ASCT. RESULTS The 3 features did not significantly differ between the 2 study groups at baseline, before, and 3 months after ASCT. Multivariate modeling showed that the baseline values were significantly related to the changes in study outcomes independent of patient and caregiver characteristics. Other correlates were caregivers' work and patient age for impact on daily activities and disease burden across time for impact on general health (all P < .05). CONCLUSION The outpatient model neither improves nor impairs global caregivers' burden compared to standard ASCT care. Further research is needed to confirm this observation and to better assess the burden and quality of life of caregivers and their influence on patient outcomes and quality of life.
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Affiliation(s)
- Massimo Martino
- Stem Cell Transplant Program, Clinical Section, Department of Hemato-oncology and Radiotherapy, Grande Ospedale Metropolitano Bianchi-Melacrino-Morelli, Reggio Calabria, Italy.
| | | | - Giovanni Tripepi
- CNR-IFC, Research Unit of Reggio Calabria, Reggio Calabria, Italy
| | - Annalisa Paviglianiti
- Stem Cell Transplant Program, Clinical Section, Department of Hemato-oncology and Radiotherapy, Grande Ospedale Metropolitano Bianchi-Melacrino-Morelli, Reggio Calabria, Italy
| | - Letteria Russo
- Stem Cell Transplant Program, Clinical Section, Department of Hemato-oncology and Radiotherapy, Grande Ospedale Metropolitano Bianchi-Melacrino-Morelli, Reggio Calabria, Italy
| | - Giuseppa Cusumano
- Stem Cell Transplant Program, Clinical Section, Department of Hemato-oncology and Radiotherapy, Grande Ospedale Metropolitano Bianchi-Melacrino-Morelli, Reggio Calabria, Italy
| | - Antonio Rossetti
- Stem Cell Transplant Program, Clinical Section, Department of Hemato-oncology and Radiotherapy, Grande Ospedale Metropolitano Bianchi-Melacrino-Morelli, Reggio Calabria, Italy
| | - Pasquale Fabio Provenzano
- Stem Cell Transplant Program, Clinical Section, Department of Hemato-oncology and Radiotherapy, Grande Ospedale Metropolitano Bianchi-Melacrino-Morelli, Reggio Calabria, Italy
| | - Gaetana Porto
- Stem Cell Transplant Program, Clinical Section, Department of Hemato-oncology and Radiotherapy, Grande Ospedale Metropolitano Bianchi-Melacrino-Morelli, Reggio Calabria, Italy
| | - Nicola Meliambro
- Stem Cell Transplant Program, Clinical Section, Department of Hemato-oncology and Radiotherapy, Grande Ospedale Metropolitano Bianchi-Melacrino-Morelli, Reggio Calabria, Italy
| | - Salvatore Gallo
- Stem Cell Transplant Program, Clinical Section, Department of Hemato-oncology and Radiotherapy, Grande Ospedale Metropolitano Bianchi-Melacrino-Morelli, Reggio Calabria, Italy
| | - Domenico Porcino
- Stem Cell Transplant Program, Clinical Section, Department of Hemato-oncology and Radiotherapy, Grande Ospedale Metropolitano Bianchi-Melacrino-Morelli, Reggio Calabria, Italy
| | - Valentina Romeo
- Stem Cell Transplant Program, Clinical Section, Department of Hemato-oncology and Radiotherapy, Grande Ospedale Metropolitano Bianchi-Melacrino-Morelli, Reggio Calabria, Italy
| | - Tiziana Gangemi
- Stem Cell Transplant Program, Clinical Section, Department of Hemato-oncology and Radiotherapy, Grande Ospedale Metropolitano Bianchi-Melacrino-Morelli, Reggio Calabria, Italy
| | | | - Lucrezia Imbalzano
- Stem Cell Transplant Program, Clinical Section, Department of Hemato-oncology and Radiotherapy, Grande Ospedale Metropolitano Bianchi-Melacrino-Morelli, Reggio Calabria, Italy
| | - Giuseppe Console
- Stem Cell Transplant Program, Clinical Section, Department of Hemato-oncology and Radiotherapy, Grande Ospedale Metropolitano Bianchi-Melacrino-Morelli, Reggio Calabria, Italy
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Martino M, Paviglianiti A, Memoli M, Martinelli G, Cerchione C. Multiple Myeloma Outpatient Transplant Program in the Era of Novel Agents: State-of-the-Art. Front Oncol 2020; 10:592487. [PMID: 33262948 PMCID: PMC7686536 DOI: 10.3389/fonc.2020.592487] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/07/2020] [Accepted: 10/19/2020] [Indexed: 01/16/2023] Open
Abstract
Multiple myeloma (MM) is the most common indication for autologous stem cell transplantation (ASCT), and outpatient models have been widely developed in this setting. Although numerous studies have demonstrated the safety and feasibility of outpatient ASCT, it is not a routine procedure. Stringent guidelines for patient selection and clinical management, including functional status, caregiver support, and psychological aspects, are essential to identify eligible patients. However, there is still no general agreement on these criteria. Quality of life data are limited and contradictory. There is considerable variability in outpatient transplant models, and there are no randomised studies supporting the use of one over the other. Studies evaluating results in terms of long-term survival, transplant toxicity in comparison with a standard approach are lacking. The procedure is cost-effective within the context of a hospital budget, but an in-depth analysis of the real cost of these programmes has yet to be performed.
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Affiliation(s)
- Massimo Martino
- Stem Cell Transplant Program, Clinical Section, Department of Hemato-Oncology and Radiotherapy, Grande Ospedale Metropolitano "Bianchi-Melacrino-Morelli", Reggio Calabria, Italy
| | - Annalisa Paviglianiti
- Stem Cell Transplant Program, Clinical Section, Department of Hemato-Oncology and Radiotherapy, Grande Ospedale Metropolitano "Bianchi-Melacrino-Morelli", Reggio Calabria, Italy
| | - Mara Memoli
- Department of Hematology and Cellular Therapy, Saint Antoine Hospital, AP-HP, Paris, France.,Department of Medicine and Surgery, Hematology and Hematopoietic Stem Cell Transplant Center, University of Naples Federico II, Naples, Italy
| | - Giovanni Martinelli
- Hematology Unit, Istituto Scientifico Romagnolo per lo Studio e la Cura dei Tumori (IRST) IRCCS, Meldola, Italy
| | - Claudio Cerchione
- Hematology Unit, Istituto Scientifico Romagnolo per lo Studio e la Cura dei Tumori (IRST) IRCCS, Meldola, Italy
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Kisch AM, Bergkvist K, Alvariza A, Årestedt K, Winterling J. Family caregivers' support needs during allo-HSCT-a longitudinal study. Support Care Cancer 2020; 29:3347-3356. [PMID: 33125539 PMCID: PMC8062346 DOI: 10.1007/s00520-020-05853-8] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/17/2020] [Accepted: 10/22/2020] [Indexed: 01/04/2023]
Abstract
PURPOSE The study aimed to explore family caregivers' support needs prior to allo-HSCT, how these change over time and whether they are associated with demographic factors and caregiver outcome. METHODS This longitudinal repeated measure study included 87 family caregivers of allo-HSCT recipients: 63% were partners, 74% women, 65% lived with the recipient, and their mean age was 54 years. They completed the 14-item Carer Support Needs Assessment Tool (CSNAT) and caregiver outcome measures (caregiver burden, anxiety, depression, preparedness for caregiving and general health) prior to allo-HSCT and 3, 6 and 16 weeks later. RESULTS The two top support needs prior to allo-HSCT were 'knowing what to expect in the future' (79%) and 'dealing with your own feelings' (70%). Several support needs were associated with younger age and not being a partner, while higher needs implied worse caregiver outcomes for at least one of the outcomes prior to transplantation. Most support needs remained the same at the last follow-up. CONCLUSION The findings that high support needs are often associated with worse caregiver outcomes and most support needs do not diminish over time indicate that more attention should be placed on the situation of family caregivers.
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Affiliation(s)
- Annika M Kisch
- Haematology Department, Lund University Hospital, Lund, Sweden. .,Institute of Health Sciences, Lund University, Lund, Sweden.
| | - Karin Bergkvist
- Department of Neurobiology, Care Sciences and Society, Karolinska Institutet, Stockholm, Sweden.,Sophiahemmet University, Stockholm, Sweden
| | - Anette Alvariza
- Department of Health Care Sciences/Palliative Research Centre, Ersta Sköndal Bräcke University College, Stockholm, Sweden
| | - Kristofer Årestedt
- Faculty of Health and Life Sciences, Linnaeus University, Kalmar, Sweden.,The Research Section, Region Kalmar County, Kalmar, Sweden
| | - Jeanette Winterling
- Department of Neurobiology, Care Sciences and Society, Karolinska Institutet, Stockholm, Sweden.,Medical Unit Hematology, Theme Cancer, Karolinska University Hospital, Stockholm, Sweden
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Rozwadowski M, Dittakavi M, Mazzoli A, Hassett AL, Braun T, Barton DL, Carlozzi N, Sen S, Tewari M, Hanauer DA, Choi SW. Promoting Health and Well-Being Through Mobile Health Technology (Roadmap 2.0) in Family Caregivers and Patients Undergoing Hematopoietic Stem Cell Transplantation: Protocol for the Development of a Mobile Randomized Controlled Trial. JMIR Res Protoc 2020; 9:e19288. [PMID: 32945777 PMCID: PMC7532463 DOI: 10.2196/19288] [Citation(s) in RCA: 13] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/13/2020] [Revised: 06/26/2020] [Accepted: 07/14/2020] [Indexed: 12/18/2022] Open
Abstract
Background Cancer patients who undergo allogeneic hematopoietic stem cell transplantation are among the most medically fragile patient populations with extreme demands for caregivers. Indeed, with earlier hospital discharges, the demands placed on caregivers continue to intensify. Moreover, an increased number of allogeneic hematopoietic stem cell transplantations are being performed worldwide, and this expensive procedure has significant economic consequences. Thus, the health and well-being of family caregivers have attracted widespread attention. Mobile health technology has been shown to deliver flexible, and time- and cost-sparing interventions to support family caregivers across the care trajectory. Objective This protocol aims to leverage technology to deliver a novel caregiver-facing mobile health intervention named Roadmap 2.0. We will evaluate the effectiveness of Roadmap 2.0 in family caregivers of patients undergoing hematopoietic stem cell transplantation. Methods The Roadmap 2.0 intervention will consist of a mobile randomized trial comparing a positive psychology intervention arm with a control arm in family caregiver-patient dyads. The primary outcome will be caregiver health-related quality of life, as assessed by the PROMIS Global Health scale at day 120 post-transplant. Secondary outcomes will include other PROMIS caregiver- and patient-reported outcomes, including companionship, self-efficacy for managing symptoms, self-efficacy for managing daily activities, positive affect and well-being, sleep disturbance, depression, and anxiety. Semistructured qualitative interviews will be conducted among participants at the completion of the study. We will also measure objective physiological markers (eg, sleep, activity, heart rate) through wearable wrist sensors and health care utilization data through electronic health records. Results We plan to enroll 166 family caregiver-patient dyads for the full data analysis. The study has received Institutional Review Board approval as well as Code Review and Information Assurance approval from our health information technology services. Owing to the COVID-19 pandemic, the study has been briefly put on hold. However, recruitment began in August 2020. We have converted all recruitment, enrollment, and onboarding processes to be conducted remotely through video telehealth. Consent will be obtained electronically through the Roadmap 2.0 app. Conclusions This mobile randomized trial will determine if positive psychology-based activities delivered through mobile health technology can improve caregiver health-related quality of life over a 16-week study period. This study will provide additional data on the effects of wearable wrist sensors on caregiver and patient self-report outcomes. Trial Registration ClinicalTrials.gov NCT04094844; https://www.clinicaltrials.gov/ct2/show/NCT04094844 International Registered Report Identifier (IRRID) PRR1-10.2196/19288
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Affiliation(s)
- Michelle Rozwadowski
- Department of Pediatrics, Michigan Medicine, University of Michigan, Ann Arbor, MI, United States
| | - Manasa Dittakavi
- Department of Pediatrics, Michigan Medicine, University of Michigan, Ann Arbor, MI, United States
| | - Amanda Mazzoli
- Department of Pediatrics, Michigan Medicine, University of Michigan, Ann Arbor, MI, United States
| | - Afton L Hassett
- Department of Anesthesia, Michigan Medicine, University of Michigan, Ann Arbor, MI, United States
| | - Thomas Braun
- Department of Biostatistics, School of Public Health, University of Michigan, Ann Arbor, MI, United States
| | - Debra L Barton
- School of Nursing, University of Michigan, Ann Arbor, MI, United States
| | - Noelle Carlozzi
- Department of Physical Medicine and Rehabilitation, Michigan Medicine, University of Michigan, Ann Arbor, MI, United States
| | - Srijan Sen
- Department of Psychiatry, Michigan Medicine, University of Michigan, Ann Arbor, MI, United States
| | - Muneesh Tewari
- Department of Internal Medicine, Michigan Medicine, University of Michigan, Ann Arbor, MI, United States
| | - David A Hanauer
- Department of Pediatrics, Michigan Medicine, University of Michigan, Ann Arbor, MI, United States
| | - Sung Won Choi
- Department of Pediatrics, Michigan Medicine, University of Michigan, Ann Arbor, MI, United States
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25
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Morency JL, Caldon KL, Root L, Hayes CA, Brighton S, Lyons KD. Feasibility study of a wellness intervention for caregivers of patients undergoing hematopoietic stem cell transplantation: The Ready to CARE Intervention. Br J Occup Ther 2020. [DOI: 10.1177/0308022620950980] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
Introduction Caregivers of patients undergoing hematopoietic stem cell transplantation need encouragement to maintain their own wellbeing. This feasibility study explored a six-session wellness intervention for caregivers entitled Ready to CARE (Connect, Actively Relax, and Exercise). Method This study used a single-arm pre–post design to explore the feasibility and acceptability of the intervention and study procedures. The individual, participant-directed intervention was initiated at hospitalization for stem cell reinfusion. Caregivers completed telephone surveys on four occasions and engaged in one semi-structured interview to share their perceptions of the intervention. Results Twenty participants enrolled and completed the baseline survey, with 50%, 90%, and 80% completing the subsequent three surveys, respectively. Seventy-four percent completed all six sessions of the intervention. Caregivers most often used the sessions to set goals related to physical activity (36%), stress management (14%), sleep (13%), and caregiving tasks (11%). Caregivers reported appreciation of the intervention’s focus on supporting caregivers, taking action with goal-setting, and allowing caregivers to determine the focus of the goals. Scheduling the sessions was the most problematic aspect of the intervention. Conclusion While caregivers were open to a wellness intervention, a high degree of flexibility and tailoring is needed to engage and support busy caregivers. Clinical Trial Registration: NCT03210727
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Affiliation(s)
- Jamme L Morency
- Department of Physical Medicine and Rehabilitation, Dartmouth-Hitchcock Medical Center, Lebanon, NH, USA
| | - Kate L Caldon
- Bone Marrow Transplant Program, Section of Hematology Oncology, Dartmouth-Hitchcock Medical Center, Lebanon, NH, USA
| | - Lynn Root
- Bone Marrow Transplant Program, Section of Hematology Oncology, Dartmouth-Hitchcock Medical Center, Lebanon, NH, USA
| | - Christi A Hayes
- Bone Marrow Transplant Program, Section of Hematology Oncology, Dartmouth-Hitchcock Medical Center, Lebanon, NH, USA
- Department of Medicine, Geisel School of Medicine, Hanover, NH, USA
| | - Susan Brighton
- Bone Marrow Transplant Program, Section of Hematology Oncology, Dartmouth-Hitchcock Medical Center, Lebanon, NH, USA
| | - Kathleen Doyle Lyons
- Department of Psychiatry Research, Dartmouth-Hitchcock Medical Center, Lebanon, NH, USA
- Department of Psychiatry, Geisel School of Medicine at Dartmouth, Hanover, NH, USA
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Samaha R, Kattan J. Hematopoietic stem cell transplantation dilemma during the COVID-19 era. Future Oncol 2020; 16:1569-1573. [PMID: 32458703 PMCID: PMC7255427 DOI: 10.2217/fon-2020-0414] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/26/2022] Open
Affiliation(s)
- Ramy Samaha
- Hotel-Dieu de France University Hospital, Faculty of Medicine, Saint Joseph University, Beirut, Lebanon
| | - Joseph Kattan
- Hotel-Dieu de France University Hospital, Faculty of Medicine, Saint Joseph University, Beirut, Lebanon
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El-Jawahri A, Jacobs JM, Nelson AM, Traeger L, Greer JA, Nicholson S, Waldman LP, Fenech AL, Jagielo AD, D’Alotto J, Horick N, Spitzer T, DeFilipp Z, Chen YBA, Temel JS. Multimodal psychosocial intervention for family caregivers of patients undergoing hematopoietic stem cell transplantation: A randomized clinical trial. Cancer 2020; 126:1758-1765. [PMID: 31899552 PMCID: PMC7103553 DOI: 10.1002/cncr.32680] [Citation(s) in RCA: 29] [Impact Index Per Article: 7.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/15/2019] [Revised: 11/20/2019] [Accepted: 12/03/2019] [Indexed: 11/08/2022]
Abstract
BACKGROUND Caregivers of patients undergoing hematopoietic stem cell transplantation (HCT) experience an immense caregiving burden before, during, and after HCT. METHODS We conducted an unblinded, randomized trial of a psychosocial intervention (BMT-CARE) for caregivers of patients undergoing autologous and allogeneic HCT at Massachusetts General Hospital. Caregivers were randomly assigned to BMT-CARE or usual care. BMT-CARE was tailored to the HCT trajectory and integrated treatment-related education and self-care with cognitive-behavioral skills to promote coping. Caregivers assigned to BMT-CARE met with a trained interventionist (a psychologist or a social worker) in person, via telephone, or via videoconferencing for 6 sessions starting before HCT and continuing up to day +60 after HCT. The primary endpoint was feasibility, which was defined as at least 60% of eligible caregivers enrolling and completing 50% or more of the intervention sessions. We assesed caregiver quality of life (QOL; Caregiver Oncology Quality of Life Questionnaire), caregiving burden (Caregiver Reaction Assessment), psychological distress (Hospital Anxiety and Depression Scale), self-efficacy (Cancer Self-Efficacy Scale-Transplant), and coping (Measures of Current Status) at baseline and 30 and 60 days after HCT. We used mixed linear effect models to assess the effect of BMT-CARE on outcomes longitudinally. RESULTS We enrolled 72.5% of eligible caregivers (100 of 138), and 80% attended 50% or more of the intervention sessions. Caregivers randomized to BMT-CARE reported improved QOL (B = 6.11; 95% CI, 3.50-8.71; P < .001), reduced caregiving burden (B = -6.02; 95% CI, -8.49 to -3.55; P < .001), lower anxiety (B = -2.18; 95% CI, -3.07 to -1.28; P < .001) and depression symptoms (B = -1.23; 95% CI, -1.92 to -0.54; P < .001), and improved self-efficacy (B = 7.22; 95% CI, 2.40-12.03; P = .003) and coping skills (B = 4.83; 95% CI, 3.04-6.94; P < .001) in comparison with the usual-care group. CONCLUSIONS A brief multimodal psychosocial intervention tailored for caregivers of HCT recipients is feasible and may improve QOL, mood, coping, and self-efficacy while reducing the caregiving burden during the acute HCT period.
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Affiliation(s)
- Areej El-Jawahri
- Massachusetts General Hospital, 55 Fruit Street, Boston, Massachusetts, 02134
- Harvard Medical School, Boston, Massachusetts, 02114
| | - Jamie M. Jacobs
- Massachusetts General Hospital, 55 Fruit Street, Boston, Massachusetts, 02134
- Harvard Medical School, Boston, Massachusetts, 02114
| | - Ashley M. Nelson
- Massachusetts General Hospital, 55 Fruit Street, Boston, Massachusetts, 02134
- Harvard Medical School, Boston, Massachusetts, 02114
| | - Lara Traeger
- Massachusetts General Hospital, 55 Fruit Street, Boston, Massachusetts, 02134
- Harvard Medical School, Boston, Massachusetts, 02114
| | - Joseph A. Greer
- Massachusetts General Hospital, 55 Fruit Street, Boston, Massachusetts, 02134
- Harvard Medical School, Boston, Massachusetts, 02114
| | - Showly Nicholson
- Massachusetts General Hospital, 55 Fruit Street, Boston, Massachusetts, 02134
- Harvard Medical School, Boston, Massachusetts, 02114
| | - Lauren P. Waldman
- Massachusetts General Hospital, 55 Fruit Street, Boston, Massachusetts, 02134
- Harvard Medical School, Boston, Massachusetts, 02114
| | - Alyssa L. Fenech
- Massachusetts General Hospital, 55 Fruit Street, Boston, Massachusetts, 02134
- Harvard Medical School, Boston, Massachusetts, 02114
| | - Annemarie D. Jagielo
- Massachusetts General Hospital, 55 Fruit Street, Boston, Massachusetts, 02134
- Harvard Medical School, Boston, Massachusetts, 02114
| | - Jennifer D’Alotto
- Massachusetts General Hospital, 55 Fruit Street, Boston, Massachusetts, 02134
- Harvard Medical School, Boston, Massachusetts, 02114
| | - Nora Horick
- Massachusetts General Hospital, 55 Fruit Street, Boston, Massachusetts, 02134
- Harvard Medical School, Boston, Massachusetts, 02114
| | - Thomas Spitzer
- Massachusetts General Hospital, 55 Fruit Street, Boston, Massachusetts, 02134
- Harvard Medical School, Boston, Massachusetts, 02114
| | - Zachariah DeFilipp
- Massachusetts General Hospital, 55 Fruit Street, Boston, Massachusetts, 02134
- Harvard Medical School, Boston, Massachusetts, 02114
| | - Yi-Bin A. Chen
- Massachusetts General Hospital, 55 Fruit Street, Boston, Massachusetts, 02134
- Harvard Medical School, Boston, Massachusetts, 02114
| | - Jennifer S. Temel
- Massachusetts General Hospital, 55 Fruit Street, Boston, Massachusetts, 02134
- Harvard Medical School, Boston, Massachusetts, 02114
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Langer SL, Yi JC, Chi NC, Lindhorst T. Psychological Impacts and Ways of Coping Reported by Spousal Caregivers of Hematopoietic Cell Transplant Recipients: A Qualitative Analysis. Biol Blood Marrow Transplant 2020; 26:764-771. [DOI: 10.1016/j.bbmt.2019.11.023] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/16/2019] [Revised: 11/08/2019] [Accepted: 11/18/2019] [Indexed: 12/20/2022]
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Bergkvist K, Winterling J, Kisch AM. Support in the context of allogeneic hematopoietic stem cell transplantation - The perspectives of family caregivers. Eur J Oncol Nurs 2020; 46:101740. [PMID: 32353737 DOI: 10.1016/j.ejon.2020.101740] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/23/2019] [Revised: 02/12/2020] [Accepted: 02/16/2020] [Indexed: 12/19/2022]
Abstract
BACKGROUND AND AIM Family caregivers are often involved in helping recipients during allogeneic hematopoietic stem cell transplantation (allo-HSCT). Although the distress that often arises along the trajectory is evident to family caregivers, research on their perceptions of providing and receiving support is limited. The aim of this study was to explore family caregivers' experiences of providing and receiving support during allo-HSCT. METHOD Data were collected through semi-structured interviews with fourteen family caregivers 16 weeks after the recipient's allo-HSCT. Inductive qualitative content analysis was used to analyse the data. RESULTS The analysis revealed four generic categories that focus on prerequisites for family caregivers' ability to provide support: Individual characteristics influence the ability to be supportive, Social context influences the ability to be supportive, Medical information provides knowledge and a sense of participation and Interaction with the healthcare organization provides a sense of participation. These prerequisites are linked in the fifth generic category: Family caregivers' support is multifaceted and dependent on the recipient's health. CONCLUSIONS Family caregivers' risk of experiencing a stronger sense of uncertainty and lack of participation is higher in the absence of the above-mentioned prerequisites. Professional support is thus required, which implies that the healthcare organization is responsible for identifying the needs of each family caregiver and delivering individualized support.
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Affiliation(s)
- Karin Bergkvist
- Sophiahemmet University, Department of Nursing Sciences Stockholm, Sweden; Department of Neurobiology, Care Sciences and Society, Karolinska Institutet, Stockholm, Sweden.
| | - Jeanette Winterling
- Department of Neurobiology, Care Sciences and Society, Karolinska Institutet, Stockholm, Sweden; Patient Area of Haematology, Theme Cancer, Karolinska University Hospital, Solna, Stockholm, Sweden
| | - Annika M Kisch
- Department of Haematology, Skåne University Hospital, Lund, Sweden; Institute of Health Sciences, Lund University, Lund, Sweden
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Kedroske J, Koblick S, Chaar D, Mazzoli A, O'Brien M, Yahng L, Vue R, Chappell G, Shin JY, Hanauer DA, Choi SW. Development of a National Caregiver Health Survey for Hematopoietic Stem Cell Transplant: Qualitative Study of Cognitive Interviews and Verbal Probing. JMIR Form Res 2020; 4:e17077. [PMID: 32012037 PMCID: PMC7005696 DOI: 10.2196/17077] [Citation(s) in RCA: 12] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/15/2019] [Revised: 12/12/2019] [Accepted: 12/16/2019] [Indexed: 12/11/2022] Open
Abstract
Background Roadmap 1.0 is a mobile health app that was previously developed for caregivers of patients who have undergone hematopoietic stem cell transplantation (HSCT). Formative research targeted toward its end users (caregivers) can help inform app design and development, allowing additional components to be incorporated into the app, which can then be tested in a future randomized controlled trial. Objective This study aimed to create a methodologically rigorous national survey that would help inform the development of Roadmap 2.0. Methods We conducted a prospective, qualitative research study that took place between November 18, 2018, and February 7, 2019, in a blood and marrow transplant unit within a large academic medical institution in the midwestern part of the United States. Cognitive interviews, including think-aloud and verbal probing techniques, were conducted in 10 adult caregivers (≥18 years) of patients who had undergone HSCT. Results Most participants were female (9/10, 90%), white (9/10, 90%), married (9/10, 90%), employed at least part time (6/10, 60%), caregivers of adult patients (7/10, 70%), and had some college education (9/10, 90%) and an annual household income of $60,000 or higher (6/10, 60%). All but one interview was audio-recorded, with permission. Overall, participants were engaged in the cognitive interview process of the draft survey, which included 7 topics. The interviews highlighted areas wherein survey items could be further refined, such as offering more response choices (eg, “NA”) or clarifying the type of transplant (eg, autologous or allogeneic) or context of transplant care (eg, pre-HSCT, during HSCT, post-HSCT, inpatient, and outpatient). Apart from these findings, the items in demographics, caregiving experiences, technology, positive activities, and mood were generally interpreted as intended. On the basis of the transcript data and field notes by the interviewer, items within self-efficacy (Caregiver Self-Efficacy Scale) and coping (Brief Coping Orientation to Problems Experienced inventory) questionnaires generated more confusion among interviewer and participants, reflecting difficulties in interpreting the meaning of some survey items. Conclusions This study incorporated the four cognitive aspects of survey methodology that describe the question-answering process—(1) comprehension, (2) information retrieval, (3) judgment and decision making, and (4) responding—by using the think-aloud and probing techniques in cognitive interviews. We conclude that this methodologically rigorous process informed revisions and improved our final questionnaire design. International Registered Report Identifier (IRRID) RR2-10.2196/resprot.49188
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Affiliation(s)
- Jacob Kedroske
- Blood and Marrow Transplantation Program, University of Michigan, Ann Arbor, MI, United States
| | - Sarah Koblick
- Blood and Marrow Transplantation Program, University of Michigan, Ann Arbor, MI, United States
| | - Dima Chaar
- School of Public Health, University of Michigan, Ann Arbor, MI, United States
| | - Amanda Mazzoli
- Blood and Marrow Transplantation Program, University of Michigan, Ann Arbor, MI, United States
| | - Maureen O'Brien
- Institute for Social Research, Survey Research Operations, University of Michigan, Ann Arbor, MI, United States
| | - Lilian Yahng
- Center for Survey Research, Indiana University, Bloomington, IN, United States
| | - Rebecca Vue
- Blood and Marrow Transplantation Program, University of Michigan, Ann Arbor, MI, United States
| | - Grant Chappell
- Blood and Marrow Transplantation Program, University of Michigan, Ann Arbor, MI, United States
| | - Ji Youn Shin
- College of Communication Arts and Sciences, Michigan State University, East Lansing, MI, United States
| | - David A Hanauer
- Michigan Institute for Clinical and Health Research, University of Michigan, Ann Arbor, MI, United States
| | - Sung Won Choi
- Blood and Marrow Transplantation Program, University of Michigan, Ann Arbor, MI, United States
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Dionne-Odom JN, Currie ER, Johnston EE, Rosenberg AR. Supporting Family Caregivers of Adult and Pediatric Persons with Leukemia. Semin Oncol Nurs 2019; 35:150954. [DOI: 10.1016/j.soncn.2019.150954] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
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32
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Runaas L, Hoodin F, Munaco A, Fauer A, Sankaran R, Churay T, Mohammed S, Seyedsalehi S, Chappell G, Carlozzi N, Fetters MD, Kentor R, McDiarmid L, Brookshire K, Warfield C, Byrd M, Kaziunas S, Maher M, Magenau J, An L, Cohn A, Hanauer DA, Choi SW. Novel Health Information Technology Tool Use by Adult Patients Undergoing Allogeneic Hematopoietic Cell Transplantation: Longitudinal Quantitative and Qualitative Patient-Reported Outcomes. JCO Clin Cancer Inform 2019; 2:1-12. [PMID: 30652535 PMCID: PMC6873938 DOI: 10.1200/cci.17.00110] [Citation(s) in RCA: 16] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/06/2023] Open
Abstract
Purpose Health information technology (IT) is an ideal medium to improve the delivery of patient-centered care and increase patient engagement. Health IT interventions should be designed with the end user in mind and be specific to the needs of a given population. Hematopoietic cell transplantation (HCT), commonly referred to as blood and marrow transplantation (BMT), is a prime example of a complex medical procedure where patient-caregiver-provider engagement is central to a safe and successful outcome. We have previously reported on the design and development of an HCT-specific health IT tool, BMT Roadmap. Methods This study highlights longitudinal quantitative and qualitative patient-reported outcomes (PROs) in 20 adult patients undergoing allogeneic HCT. Patients completed PROs at three time points (baseline, day 30 post-HTC, and day 100 post-HCT) and provided weekly qualitative data through semistructured interviews while using BMT Roadmap. Results The mean hospital stay was 23.3 days (range, 17 to 37 days), and patients had access to BMT Roadmap for a mean of 21.3 days (range, 15 to 37 days). The total time spent on BMT Roadmap ranged from 0 to 139 minutes per patient, with a mean of 55 minutes (standard deviation, 47.6 minutes). We found that patients readily engaged with the tool and completed qualitative interviews and quantitative PROs. The Patient Activation Measure, a validated measure of patient engagement, increased for patients from baseline to discharge and day 100. Activation was significantly and negatively correlated with depression and anxiety PROs at discharge, suggesting that this may be an important time point for intervention. Conclusion Given the feasibility and promising results reported in this study, next steps include expanding our current health IT platform and implementing a randomized trial to assess the impact of BMT Roadmap on critical PROs.
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Affiliation(s)
- Lyndsey Runaas
- Lyndsey Runaas, Flora Hoodin, Tracey Churay, Saara Mohammed, Sajjad Seyedsalehi, Grant Chappell, Noelle Carlozzi, Michael D. Fetters, Sharon Kaziunas, Molly Maher, John Magenau, Larry An, David A. Hanauer, and Sung Won Choi, Michigan Medicine; Anna Munaco, Alex Fauer, Roshun Sankaran, and Amy Cohn, University of Michigan College of Engineering, Ann Arbor; and Flora Hoodin, Rachel Kentor, Leah McDiarmid, Kristina Brookshire, Casiana Warfield, and Michelle Byrd, Eastern Michigan University, Ypsilanti, MI
| | - Flora Hoodin
- Lyndsey Runaas, Flora Hoodin, Tracey Churay, Saara Mohammed, Sajjad Seyedsalehi, Grant Chappell, Noelle Carlozzi, Michael D. Fetters, Sharon Kaziunas, Molly Maher, John Magenau, Larry An, David A. Hanauer, and Sung Won Choi, Michigan Medicine; Anna Munaco, Alex Fauer, Roshun Sankaran, and Amy Cohn, University of Michigan College of Engineering, Ann Arbor; and Flora Hoodin, Rachel Kentor, Leah McDiarmid, Kristina Brookshire, Casiana Warfield, and Michelle Byrd, Eastern Michigan University, Ypsilanti, MI
| | - Anna Munaco
- Lyndsey Runaas, Flora Hoodin, Tracey Churay, Saara Mohammed, Sajjad Seyedsalehi, Grant Chappell, Noelle Carlozzi, Michael D. Fetters, Sharon Kaziunas, Molly Maher, John Magenau, Larry An, David A. Hanauer, and Sung Won Choi, Michigan Medicine; Anna Munaco, Alex Fauer, Roshun Sankaran, and Amy Cohn, University of Michigan College of Engineering, Ann Arbor; and Flora Hoodin, Rachel Kentor, Leah McDiarmid, Kristina Brookshire, Casiana Warfield, and Michelle Byrd, Eastern Michigan University, Ypsilanti, MI
| | - Alex Fauer
- Lyndsey Runaas, Flora Hoodin, Tracey Churay, Saara Mohammed, Sajjad Seyedsalehi, Grant Chappell, Noelle Carlozzi, Michael D. Fetters, Sharon Kaziunas, Molly Maher, John Magenau, Larry An, David A. Hanauer, and Sung Won Choi, Michigan Medicine; Anna Munaco, Alex Fauer, Roshun Sankaran, and Amy Cohn, University of Michigan College of Engineering, Ann Arbor; and Flora Hoodin, Rachel Kentor, Leah McDiarmid, Kristina Brookshire, Casiana Warfield, and Michelle Byrd, Eastern Michigan University, Ypsilanti, MI
| | - Roshun Sankaran
- Lyndsey Runaas, Flora Hoodin, Tracey Churay, Saara Mohammed, Sajjad Seyedsalehi, Grant Chappell, Noelle Carlozzi, Michael D. Fetters, Sharon Kaziunas, Molly Maher, John Magenau, Larry An, David A. Hanauer, and Sung Won Choi, Michigan Medicine; Anna Munaco, Alex Fauer, Roshun Sankaran, and Amy Cohn, University of Michigan College of Engineering, Ann Arbor; and Flora Hoodin, Rachel Kentor, Leah McDiarmid, Kristina Brookshire, Casiana Warfield, and Michelle Byrd, Eastern Michigan University, Ypsilanti, MI
| | - Tracey Churay
- Lyndsey Runaas, Flora Hoodin, Tracey Churay, Saara Mohammed, Sajjad Seyedsalehi, Grant Chappell, Noelle Carlozzi, Michael D. Fetters, Sharon Kaziunas, Molly Maher, John Magenau, Larry An, David A. Hanauer, and Sung Won Choi, Michigan Medicine; Anna Munaco, Alex Fauer, Roshun Sankaran, and Amy Cohn, University of Michigan College of Engineering, Ann Arbor; and Flora Hoodin, Rachel Kentor, Leah McDiarmid, Kristina Brookshire, Casiana Warfield, and Michelle Byrd, Eastern Michigan University, Ypsilanti, MI
| | - Saara Mohammed
- Lyndsey Runaas, Flora Hoodin, Tracey Churay, Saara Mohammed, Sajjad Seyedsalehi, Grant Chappell, Noelle Carlozzi, Michael D. Fetters, Sharon Kaziunas, Molly Maher, John Magenau, Larry An, David A. Hanauer, and Sung Won Choi, Michigan Medicine; Anna Munaco, Alex Fauer, Roshun Sankaran, and Amy Cohn, University of Michigan College of Engineering, Ann Arbor; and Flora Hoodin, Rachel Kentor, Leah McDiarmid, Kristina Brookshire, Casiana Warfield, and Michelle Byrd, Eastern Michigan University, Ypsilanti, MI
| | - Sajjad Seyedsalehi
- Lyndsey Runaas, Flora Hoodin, Tracey Churay, Saara Mohammed, Sajjad Seyedsalehi, Grant Chappell, Noelle Carlozzi, Michael D. Fetters, Sharon Kaziunas, Molly Maher, John Magenau, Larry An, David A. Hanauer, and Sung Won Choi, Michigan Medicine; Anna Munaco, Alex Fauer, Roshun Sankaran, and Amy Cohn, University of Michigan College of Engineering, Ann Arbor; and Flora Hoodin, Rachel Kentor, Leah McDiarmid, Kristina Brookshire, Casiana Warfield, and Michelle Byrd, Eastern Michigan University, Ypsilanti, MI
| | - Grant Chappell
- Lyndsey Runaas, Flora Hoodin, Tracey Churay, Saara Mohammed, Sajjad Seyedsalehi, Grant Chappell, Noelle Carlozzi, Michael D. Fetters, Sharon Kaziunas, Molly Maher, John Magenau, Larry An, David A. Hanauer, and Sung Won Choi, Michigan Medicine; Anna Munaco, Alex Fauer, Roshun Sankaran, and Amy Cohn, University of Michigan College of Engineering, Ann Arbor; and Flora Hoodin, Rachel Kentor, Leah McDiarmid, Kristina Brookshire, Casiana Warfield, and Michelle Byrd, Eastern Michigan University, Ypsilanti, MI
| | - Noelle Carlozzi
- Lyndsey Runaas, Flora Hoodin, Tracey Churay, Saara Mohammed, Sajjad Seyedsalehi, Grant Chappell, Noelle Carlozzi, Michael D. Fetters, Sharon Kaziunas, Molly Maher, John Magenau, Larry An, David A. Hanauer, and Sung Won Choi, Michigan Medicine; Anna Munaco, Alex Fauer, Roshun Sankaran, and Amy Cohn, University of Michigan College of Engineering, Ann Arbor; and Flora Hoodin, Rachel Kentor, Leah McDiarmid, Kristina Brookshire, Casiana Warfield, and Michelle Byrd, Eastern Michigan University, Ypsilanti, MI
| | - Michael D Fetters
- Lyndsey Runaas, Flora Hoodin, Tracey Churay, Saara Mohammed, Sajjad Seyedsalehi, Grant Chappell, Noelle Carlozzi, Michael D. Fetters, Sharon Kaziunas, Molly Maher, John Magenau, Larry An, David A. Hanauer, and Sung Won Choi, Michigan Medicine; Anna Munaco, Alex Fauer, Roshun Sankaran, and Amy Cohn, University of Michigan College of Engineering, Ann Arbor; and Flora Hoodin, Rachel Kentor, Leah McDiarmid, Kristina Brookshire, Casiana Warfield, and Michelle Byrd, Eastern Michigan University, Ypsilanti, MI
| | - Rachel Kentor
- Lyndsey Runaas, Flora Hoodin, Tracey Churay, Saara Mohammed, Sajjad Seyedsalehi, Grant Chappell, Noelle Carlozzi, Michael D. Fetters, Sharon Kaziunas, Molly Maher, John Magenau, Larry An, David A. Hanauer, and Sung Won Choi, Michigan Medicine; Anna Munaco, Alex Fauer, Roshun Sankaran, and Amy Cohn, University of Michigan College of Engineering, Ann Arbor; and Flora Hoodin, Rachel Kentor, Leah McDiarmid, Kristina Brookshire, Casiana Warfield, and Michelle Byrd, Eastern Michigan University, Ypsilanti, MI
| | - Leah McDiarmid
- Lyndsey Runaas, Flora Hoodin, Tracey Churay, Saara Mohammed, Sajjad Seyedsalehi, Grant Chappell, Noelle Carlozzi, Michael D. Fetters, Sharon Kaziunas, Molly Maher, John Magenau, Larry An, David A. Hanauer, and Sung Won Choi, Michigan Medicine; Anna Munaco, Alex Fauer, Roshun Sankaran, and Amy Cohn, University of Michigan College of Engineering, Ann Arbor; and Flora Hoodin, Rachel Kentor, Leah McDiarmid, Kristina Brookshire, Casiana Warfield, and Michelle Byrd, Eastern Michigan University, Ypsilanti, MI
| | - Kristina Brookshire
- Lyndsey Runaas, Flora Hoodin, Tracey Churay, Saara Mohammed, Sajjad Seyedsalehi, Grant Chappell, Noelle Carlozzi, Michael D. Fetters, Sharon Kaziunas, Molly Maher, John Magenau, Larry An, David A. Hanauer, and Sung Won Choi, Michigan Medicine; Anna Munaco, Alex Fauer, Roshun Sankaran, and Amy Cohn, University of Michigan College of Engineering, Ann Arbor; and Flora Hoodin, Rachel Kentor, Leah McDiarmid, Kristina Brookshire, Casiana Warfield, and Michelle Byrd, Eastern Michigan University, Ypsilanti, MI
| | - Casiana Warfield
- Lyndsey Runaas, Flora Hoodin, Tracey Churay, Saara Mohammed, Sajjad Seyedsalehi, Grant Chappell, Noelle Carlozzi, Michael D. Fetters, Sharon Kaziunas, Molly Maher, John Magenau, Larry An, David A. Hanauer, and Sung Won Choi, Michigan Medicine; Anna Munaco, Alex Fauer, Roshun Sankaran, and Amy Cohn, University of Michigan College of Engineering, Ann Arbor; and Flora Hoodin, Rachel Kentor, Leah McDiarmid, Kristina Brookshire, Casiana Warfield, and Michelle Byrd, Eastern Michigan University, Ypsilanti, MI
| | - Michelle Byrd
- Lyndsey Runaas, Flora Hoodin, Tracey Churay, Saara Mohammed, Sajjad Seyedsalehi, Grant Chappell, Noelle Carlozzi, Michael D. Fetters, Sharon Kaziunas, Molly Maher, John Magenau, Larry An, David A. Hanauer, and Sung Won Choi, Michigan Medicine; Anna Munaco, Alex Fauer, Roshun Sankaran, and Amy Cohn, University of Michigan College of Engineering, Ann Arbor; and Flora Hoodin, Rachel Kentor, Leah McDiarmid, Kristina Brookshire, Casiana Warfield, and Michelle Byrd, Eastern Michigan University, Ypsilanti, MI
| | - Sharon Kaziunas
- Lyndsey Runaas, Flora Hoodin, Tracey Churay, Saara Mohammed, Sajjad Seyedsalehi, Grant Chappell, Noelle Carlozzi, Michael D. Fetters, Sharon Kaziunas, Molly Maher, John Magenau, Larry An, David A. Hanauer, and Sung Won Choi, Michigan Medicine; Anna Munaco, Alex Fauer, Roshun Sankaran, and Amy Cohn, University of Michigan College of Engineering, Ann Arbor; and Flora Hoodin, Rachel Kentor, Leah McDiarmid, Kristina Brookshire, Casiana Warfield, and Michelle Byrd, Eastern Michigan University, Ypsilanti, MI
| | - Molly Maher
- Lyndsey Runaas, Flora Hoodin, Tracey Churay, Saara Mohammed, Sajjad Seyedsalehi, Grant Chappell, Noelle Carlozzi, Michael D. Fetters, Sharon Kaziunas, Molly Maher, John Magenau, Larry An, David A. Hanauer, and Sung Won Choi, Michigan Medicine; Anna Munaco, Alex Fauer, Roshun Sankaran, and Amy Cohn, University of Michigan College of Engineering, Ann Arbor; and Flora Hoodin, Rachel Kentor, Leah McDiarmid, Kristina Brookshire, Casiana Warfield, and Michelle Byrd, Eastern Michigan University, Ypsilanti, MI
| | - John Magenau
- Lyndsey Runaas, Flora Hoodin, Tracey Churay, Saara Mohammed, Sajjad Seyedsalehi, Grant Chappell, Noelle Carlozzi, Michael D. Fetters, Sharon Kaziunas, Molly Maher, John Magenau, Larry An, David A. Hanauer, and Sung Won Choi, Michigan Medicine; Anna Munaco, Alex Fauer, Roshun Sankaran, and Amy Cohn, University of Michigan College of Engineering, Ann Arbor; and Flora Hoodin, Rachel Kentor, Leah McDiarmid, Kristina Brookshire, Casiana Warfield, and Michelle Byrd, Eastern Michigan University, Ypsilanti, MI
| | - Larry An
- Lyndsey Runaas, Flora Hoodin, Tracey Churay, Saara Mohammed, Sajjad Seyedsalehi, Grant Chappell, Noelle Carlozzi, Michael D. Fetters, Sharon Kaziunas, Molly Maher, John Magenau, Larry An, David A. Hanauer, and Sung Won Choi, Michigan Medicine; Anna Munaco, Alex Fauer, Roshun Sankaran, and Amy Cohn, University of Michigan College of Engineering, Ann Arbor; and Flora Hoodin, Rachel Kentor, Leah McDiarmid, Kristina Brookshire, Casiana Warfield, and Michelle Byrd, Eastern Michigan University, Ypsilanti, MI
| | - Amy Cohn
- Lyndsey Runaas, Flora Hoodin, Tracey Churay, Saara Mohammed, Sajjad Seyedsalehi, Grant Chappell, Noelle Carlozzi, Michael D. Fetters, Sharon Kaziunas, Molly Maher, John Magenau, Larry An, David A. Hanauer, and Sung Won Choi, Michigan Medicine; Anna Munaco, Alex Fauer, Roshun Sankaran, and Amy Cohn, University of Michigan College of Engineering, Ann Arbor; and Flora Hoodin, Rachel Kentor, Leah McDiarmid, Kristina Brookshire, Casiana Warfield, and Michelle Byrd, Eastern Michigan University, Ypsilanti, MI
| | - David A Hanauer
- Lyndsey Runaas, Flora Hoodin, Tracey Churay, Saara Mohammed, Sajjad Seyedsalehi, Grant Chappell, Noelle Carlozzi, Michael D. Fetters, Sharon Kaziunas, Molly Maher, John Magenau, Larry An, David A. Hanauer, and Sung Won Choi, Michigan Medicine; Anna Munaco, Alex Fauer, Roshun Sankaran, and Amy Cohn, University of Michigan College of Engineering, Ann Arbor; and Flora Hoodin, Rachel Kentor, Leah McDiarmid, Kristina Brookshire, Casiana Warfield, and Michelle Byrd, Eastern Michigan University, Ypsilanti, MI
| | - Sung Won Choi
- Lyndsey Runaas, Flora Hoodin, Tracey Churay, Saara Mohammed, Sajjad Seyedsalehi, Grant Chappell, Noelle Carlozzi, Michael D. Fetters, Sharon Kaziunas, Molly Maher, John Magenau, Larry An, David A. Hanauer, and Sung Won Choi, Michigan Medicine; Anna Munaco, Alex Fauer, Roshun Sankaran, and Amy Cohn, University of Michigan College of Engineering, Ann Arbor; and Flora Hoodin, Rachel Kentor, Leah McDiarmid, Kristina Brookshire, Casiana Warfield, and Michelle Byrd, Eastern Michigan University, Ypsilanti, MI
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Understanding coping strategies of cancer caregivers to inform mindfulness-based interventions: A qualitative study. Eur J Integr Med 2019. [DOI: 10.1016/j.eujim.2019.100936] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022]
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Kim W, Bangerter LR, Jo S, Langer S, Larkey L, Griffin J, Khera N. Feasibility and Acceptability of a 3-Day Group-Based Digital Storytelling Workshop among Caregivers of Allogeneic Hematopoietic Cell Transplantation Patients: A Mixed-Methods Approach. Biol Blood Marrow Transplant 2019; 25:2228-2233. [PMID: 31265918 DOI: 10.1016/j.bbmt.2019.06.030] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/20/2019] [Revised: 05/13/2019] [Accepted: 06/26/2019] [Indexed: 11/19/2022]
Abstract
Family caregivers are essential partners for patients undergoing hematopoietic cell transplantation (HCT). The caregiving role is emotionally, physically, and financially demanding. Intervention efforts to provide relief for caregiver stress during HCT are highly warranted. Storytelling interventions are accruing evidence for efficacy in therapeutic contexts. The purpose of this study was to conduct a 3-full consecutive day digital storytelling (DST) workshop to build knowledge on caregivers' lived experiences during HCT, to pilot test DST with a small group of HCT caregivers, and to demonstrate feasibility and acceptability using qualitative and quantitative measures. Six adult caregivers of allogeneic HCT recipients (mean age, 60.2 years) attended a 3-day DST program (66% female, 83% white). All successfully created their personal audiovisual digital story (2 to 3 minutes long) and completed a survey. All participants rated the DST workshop as highly acceptable and therapeutic (mean score 5, on a scale of 1 to 5). Group discussions and interviews with participants further demonstrated high satisfaction and acceptability of the workshop format, setting, process, and structure. The survey results showed decreases in anxiety and depression from before to after the DST workshop with all participants showing change in the expected direction. This study demonstrates the feasibility and acceptability of a 3-day DST workshop as a distress-relieving tool for HCT caregivers. Future research is needed to test the efficacy of DST relative to a control condition.
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Affiliation(s)
- Wonsun Kim
- College of Nursing and Health Innovation, Arizona State University, Phoenix, Arizona; Mayo Clinic College of Medicine, Phoenix, Arizona.
| | - Lauren R Bangerter
- Mayo Clinic Robert D. and Patricia E. Kern Center for the Science of Healthcare Delivery, Rochester, Minnesota
| | - Soojung Jo
- College of Nursing and Health Innovation, Arizona State University, Phoenix, Arizona
| | - Shelby Langer
- College of Nursing and Health Innovation, Arizona State University, Phoenix, Arizona; Mayo Clinic College of Medicine, Phoenix, Arizona
| | - Linda Larkey
- College of Nursing and Health Innovation, Arizona State University, Phoenix, Arizona; Mayo Clinic College of Medicine, Phoenix, Arizona
| | - Joan Griffin
- Mayo Clinic Robert D. and Patricia E. Kern Center for the Science of Healthcare Delivery, Rochester, Minnesota
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Quality of life and mood of older patients with acute myeloid leukemia (AML) receiving intensive and non-intensive chemotherapy. Leukemia 2019; 33:2393-2402. [PMID: 30923318 DOI: 10.1038/s41375-019-0449-1] [Citation(s) in RCA: 36] [Impact Index Per Article: 7.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/31/2018] [Revised: 03/03/2019] [Accepted: 03/08/2019] [Indexed: 02/04/2023]
Abstract
Older patients with AML face difficult treatment decisions as they can be treated either with 'intensive' chemotherapy requiring prolonged hospitalization, or 'non-intensive' chemotherapy. Although clinicians often perceive intensive chemotherapy as more burdensome, research is lacking on patients' quality of life (QOL) and psychological distress. We conducted a longitudinal study of older patients (≥60 years) newly diagnosed with AML receiving intensive (cytarabine/anthracycline combination) or non-intensive (hypomethylating agents) chemotherapy. We assessed patients' QOL [Functional-Assessment-of-Cancer-Therapy-Leukemia] and psychological distress [Hospital-Anxiety-and-Depression-Scale] at baseline and 2, 4, 8, 12, and 24 weeks after diagnosis. We enrolled 75.2% (100/133) of eligible patients within 72-hours of initiating intensive (n = 50) or non-intensive (n = 50) chemotherapy. Patient QOL improved over time (β = 0.32, P = 0.013). At baseline, 33.3% (33/100) and 30.0% (30/100) of patients reported clinically significant depression and anxiety symptoms, respectively, with no differences between groups. Patients' depression symptoms did not change over time, while their anxiety symptoms decreased over time (β = -0.08, P < 0.001). Patient-reported QOL, depression and anxiety symptoms did not differ significantly at any time point between those who received intensive versus non-intensive chemotherapy. Older patients with AML experience improvements in their QOL and anxiety while undergoing treatment. Patients receiving intensive and non-intensive chemotherapy have similar QOL and mood trajectories.
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Caregiver availability and patient access to hematopoietic cell transplantation: social worker perspectives inform practice. Support Care Cancer 2019; 27:4253-4264. [DOI: 10.1007/s00520-019-04696-2] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/01/2018] [Accepted: 02/08/2019] [Indexed: 01/09/2023]
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The Effect of Psychosocial Interventions on Outcomes for Caregivers of Hematopoietic Cell Transplant Patients. Curr Hematol Malig Rep 2018; 13:155-163. [PMID: 29705880 DOI: 10.1007/s11899-018-0445-y] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/31/2022]
Abstract
PURPOSE OF REVIEW Hematopoietic cell transplant (HCT) patients are required to have a caregiver present for up to 100 days post-transplant. Caregivers provide essential support during HCT but experience immense stress and burden. Increasing research has developed interventions for HCT caregivers. This review systematically evaluates psychosocial interventions for caregivers of HCT patients. RECENT FINDINGS The search yielded 12 studies (7 efficacy and 5 feasibility studies) enrolling 931 caregivers. Interventions were feasible and acceptable as evidenced by high rates of completion (70-100%) with attrition due to patient morbidity or mortality. Feasibility was augmented by flexible delivery (in-person, teleconference, smartphones, or Web-based platforms). Acceptability was demonstrated by objective measures of satisfaction. Effectiveness was found for fatigue and mental health service use, but not for burden, sleep-quality, and inconsistently for caregiver depression, anxiety, coping, and quality of life. Psychosocial interventions are feasible, acceptable, and show mixed effects on HCT caregiver outcomes.
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Vinci C, Reblin M, Jim H, Pidala J, Bulls H, Cutolo E. Understanding preferences for a mindfulness-based stress management program among caregivers of hematopoietic cell transplant patients. Complement Ther Clin Pract 2018; 33:164-169. [PMID: 30396616 DOI: 10.1016/j.ctcp.2018.10.007] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/01/2018] [Revised: 10/12/2018] [Accepted: 10/16/2018] [Indexed: 11/17/2022]
Abstract
Informal caregivers of allogeneic hematopoietic cell transplant patients experience significant levels of stress throughout the caregiving process. One strategy that has been shown to aid in stress management in other populations is mindfulness. The goal of this study was to understand caregivers' experiences with mindfulness and evaluate their receptiveness to a mindfulness-based stress management program. Data were collected via in-depth phone interviews from 18 caregivers (55% female). Results indicated that about half the sample was familiar with mindfulness and/or had practiced meditation. The majority indicated that they believed a mindfulness program would have been useful for them and that they would have been willing to participate. Most indicated that a program delivered once-weekly for 60 min, during both inpatient and outpatient phases, would be preferable through a combination of in-person and mobile-based delivery. These data provide critical information for the development of future mindfulness-based interventions for this caregiving population.
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Affiliation(s)
- C Vinci
- Moffitt Cancer Center, 4115 E Fowler Ave, Tampa, FL, 33629, USA.
| | - M Reblin
- Moffitt Cancer Center, 4115 E Fowler Ave, Tampa, FL, 33629, USA
| | - H Jim
- Moffitt Cancer Center, 4115 E Fowler Ave, Tampa, FL, 33629, USA
| | - J Pidala
- Moffitt Cancer Center, 4115 E Fowler Ave, Tampa, FL, 33629, USA
| | - H Bulls
- Moffitt Cancer Center, 4115 E Fowler Ave, Tampa, FL, 33629, USA
| | - E Cutolo
- Ross University, PO Box 334 Basseterre, St. Kitts West Indies, USA
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Jamani K, Onstad LE, Bar M, Carpenter PA, Krakow EF, Salit RB, Flowers MED, Lee SJ. Quality of Life of Caregivers of Hematopoietic Cell Transplant Recipients. Biol Blood Marrow Transplant 2018; 24:2271-2276. [PMID: 29935213 PMCID: PMC6242735 DOI: 10.1016/j.bbmt.2018.06.015] [Citation(s) in RCA: 28] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/30/2018] [Accepted: 06/11/2018] [Indexed: 12/15/2022]
Abstract
Caregivers are critical to recipient recovery after hematopoietic cell transplant (HCT); however, little is known about their long-term health and quality of life (QoL). In this study we surveyed 4446 caregiver-recipient pairs in the post-HCT period to describe their QoL and its determinants. In total, 849 caregiver-recipient pairs at a median of 6 years after autologous or allogeneic HCT responded. Among 849 responding caregivers at a median of 6 years post-HCT, 67% of caregivers were women and 68% indicated they were still providing care to the recipient. Mean and median QoL measures of caregivers were at or above general population norms; however, approximately 20% of caregivers reported poor QoL relative to general population norms. Multivariate analysis revealed that caregiver characteristics, including age, gender, and educational attainment, were important determinants of caregiver QoL. Additional determinants of caregiver QoL included recipient QoL, relapse after autologous HCT, and ongoing use of immunosuppression after allogeneic HCT. Additionally, the prevalence of depression and sleep disorders appear to be higher in caregivers than in the general population. We have identified a population of caregivers who may benefit from interventions aimed at improving QoL and health outcomes. HCT clinical practice should also consider caregiver well-being.
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Affiliation(s)
- Kareem Jamani
- Clinical Research Division, Fred Hutchinson Cancer Research Center, Seattle, Washington.
| | - Lynn E Onstad
- Clinical Research Division, Fred Hutchinson Cancer Research Center, Seattle, Washington
| | - Merav Bar
- Clinical Research Division, Fred Hutchinson Cancer Research Center, Seattle, Washington
| | - Paul A Carpenter
- Clinical Research Division, Fred Hutchinson Cancer Research Center, Seattle, Washington
| | - Elizabeth F Krakow
- Clinical Research Division, Fred Hutchinson Cancer Research Center, Seattle, Washington
| | - Rachel B Salit
- Clinical Research Division, Fred Hutchinson Cancer Research Center, Seattle, Washington
| | - Mary E D Flowers
- Clinical Research Division, Fred Hutchinson Cancer Research Center, Seattle, Washington
| | - Stephanie J Lee
- Clinical Research Division, Fred Hutchinson Cancer Research Center, Seattle, Washington
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Son T, Lambert S, Jakubowski A, DiCicco-Bloom B, Loiselle CG. Adaptation of Coping Together - a self-directed coping skills intervention for patients and caregivers in an outpatient hematopoietic stem cell transplantation setting: a study protocol. BMC Health Serv Res 2018; 18:669. [PMID: 30157867 PMCID: PMC6114732 DOI: 10.1186/s12913-018-3483-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/18/2017] [Accepted: 08/20/2018] [Indexed: 11/29/2022] Open
Abstract
Background Despite numerous reports of significant distress and burden for hematopoietic stem cell transplantation (HSCT) patients and caregivers (CGs), HSCT-specific coping interventions remain rare. The few in use lack specificity and are often not easily accessible or cost-effective. Whereas the development of new interventions is resource-intensive, theory-informed adaptation of existing evidence-based interventions is promising. To date, no HSCT-specific intervention has relied on a formal adaptation approach. Methods Using the Center for Disease Control and Prevention’s Map of Adaptation, this two-phase qualitative descriptive study seeks to understand the perceptions of HSCT patients, CGs, individually, and in dyads, and clinicians about Coping Together (CT) for the preliminary adaptation (Phase 1), and then explores perceptions of the modified intervention in additional mixed sample (Phase 2). Six to ten participants including outpatients, CGs and dyads and five to seven HSCT clinician participants will be recruited for Phase 1. For Phase 2, 14 to 16 participants including outpatients, CGs and dyads will be recruited. Individual and dyadic semi-structured interviews will take place between 100 and 130 days post-HSCT. Verbatim transcripts will be analyzed using content analysis. Discussion It is paramount to have HSCT-specific supportive interventions that address patients’ and CGs’ multidimensional and complex needs. The timely involvement of key stakeholders throughout the adaptation process is likely to optimize the relevance and uptake of such tailored intervention. Trial registration This study is registered on October 6, 2016 in ClinicalTrials.gov at (identifier number NCT02928185).
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Affiliation(s)
- Tammy Son
- Department of Survivorship and Supportive Care, MSKCC, 1275 York Avenue, New York, NY, 10065, USA. .,Ingram School of Nursing, McGill University, Montreal, H3A 2A7, Canada.
| | - Sylvie Lambert
- Ingram School of Nursing, McGill University, Montreal, H3A 2A7, Canada
| | - Ann Jakubowski
- Adult Bone Marrow Transplantation Service, MSKCC, 1275 York Avenue, New York, NY, 10065, USA
| | - Barbara DiCicco-Bloom
- Department of Nursing, City University of New York, 365 Fifth Avenue, New York, NY, 10016, USA
| | - Carmen G Loiselle
- Ingram School of Nursing, McGill University, Montreal, H3A 2A7, Canada.,Department of Oncology, McGill University, Montreal, Canada.,Segal Cancer Centre, Jewish General Hospital, Montreal, Canada
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Burns LJ, Abbetti B, Arnold SD, Bender J, Doughtie S, El-Jawahiri A, Gee G, Hahn T, Horowitz MM, Johnson S, Juckett M, Krishnamurit L, Kullberg S, LeMaistre CF, Loren A, Majhail NS, Murphy EA, Rizzo D, Roche-Green A, Saber W, Schatz BA, Schmit-Pokorny K, Shaw BE, Syrjala KL, Tierney DK, Ullrich C, Vanness DJ, Wood WA, Denzen EM. Engaging Patients in Setting a Patient-Centered Outcomes Research Agenda in Hematopoietic Cell Transplantation. Biol Blood Marrow Transplant 2018; 24:1111-1118. [DOI: 10.1016/j.bbmt.2018.01.029] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/04/2018] [Accepted: 01/28/2018] [Indexed: 10/18/2022]
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Kisecik Sengul Z, Altay N. Effect of parental depression level on children's quality of life after haematopoietic stem cell transplantation. Eur J Oncol Nurs 2018; 31:90-95. [PMID: 29173833 DOI: 10.1016/j.ejon.2017.08.003] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/18/2016] [Revised: 07/20/2017] [Accepted: 08/11/2017] [Indexed: 01/01/2023]
Abstract
PURPOSE This descriptive cross-sectional study aimed to determine the impact of parental depression level on children's quality of life after haematopoietic stem cell transplantation (HSCT). METHOD This study was conducted in a bone marrow transplantation unit of a children's hospital in Ankara, Turkey. The research sample consisted of 82 parents. Children aged 2-18 years and monitored in polyclinics 100 days after HSCT were included in the study. A sociodemographic data form, parent forms of the Pediatric Quality of Life Inventory, and the Beck Depression Inventory (BDI) were used. RESULTS Forty (48%) mothers and 42 (51.2%) fathers participated in the study. Of the children, 30 (36.6%) were female and 52 (63.4%) were male, and their mean age was 10.68 [standard deviation (SD) 4.80] years. Twenty-six children (31.7%) had been diagnosed with thalassaemia, and 29 children (35.4%) had undergone HSCT in the previous 25-36 months. The mean total scale score on the Pediatric Quality of Life Inventory was 61.37 (SD 21.85), and the mean parental BDI Score was 14.57 (SD 11.03). Fourteen (17.1%) parents had severe depression and 10 (12.2%) parents had moderate depression. Low statistical correlation was found between the parental BDI score and the total scale score on the Pediatric Quality of Life (r = -0.281; P = 0.011). CONCLUSION Parental depression level affects children's quality of life after HSCT. Following transplantation, it is important to evaluate parental depression level and provide support.
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Affiliation(s)
- Zeynep Kisecik Sengul
- Department of Nursing, Faculty of Health Sciences, Suleyman Demirel University, Isparta, Turkey.
| | - Naime Altay
- Department of Nursing, Faculty of Health Sciences, Gazi University, Ankara, Turkey.
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The need to support caregivers during pediatric bone marrow transplantation (BMT): A case report. Palliat Support Care 2018; 16:367-370. [PMID: 29380715 DOI: 10.1017/s1478951517001018] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
Abstract
ABSTRACTObjective:Pediatric bone marrow transplants represent a medically stressful, potentially traumatic experience for children and caregivers, and psychological support for parental caregivers is paramount to their long-term well-being. However, many medical centers do not have protocols in place to sustain caregiver well-being during these distressing experiences. METHOD We report on a case of a 10-month-old infant with Wiskott Aldrich Syndrome who was hospitalized for bone marrow transplantation. RESULT We describe the significant burden that fell upon caregivers during and after a bone marrow transplantation. SIGNIFICANCE OF RESULTS This case helped guide our suggestions to improve care for caregivers. Several logistical hurdles could be overcome to alleviate some of these burdens. We suggest that a child psychologist or psychiatrist should be on patient care teams and be attentive to parental stress, impairments, or impediments to self-care, and signs of emergency of mental illness in this setting of medical trauma. Additionally, promotion of sleep hygiene and linkage to support systems can maximize resiliency. Finally, we believe that hospital administrators should partner with clinicians to facilitate routine support during highly stressful transitions of care.
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Nascimento JDD, Lacerda MR, Girardon-Perlini NMO, Camargo TBD, Gomes IM, Zatoni DCP. The experience of family care in transitional support houses. Rev Bras Enferm 2017; 69:538-45. [PMID: 27355304 DOI: 10.1590/0034-7167.2016690317i] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/13/2015] [Accepted: 11/15/2015] [Indexed: 11/21/2022] Open
Abstract
OBJECTIVE to present the theoretical model that represents the experience of care in transitional homes of support to families of children in a period of post-transplantation of hematopoietic stem cells. METHOD grounded theory, performed with 18 participants from three different samples. For analysis, we used the QSR Nvivo10 software. RESULTS we elaborated four categories: living in the transitional support home; experiencing care of children in post-transplantation of hematopoietic stem cells; taking care of the family caregiver; and returning to a new life at home, which interrelate according to the theoretical code of the interactive family. CONCLUSION this research contributes to understanding the experience of care in transitional support homes of families with children in post-transplantation of hematopoietic stem cells and subsidizes nursing and health actions provided to this population; it also contributes to the development of a hospital discharge guidance and care directed to this clientele.
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Affiliation(s)
| | - Maria Ribeiro Lacerda
- Programa de Pós-Graduação em Enfermagem, Universidade Federal do Paraná, Curitiba, PR, Brazil
| | | | | | - Ingrid Meireles Gomes
- Programa de Pós-Graduação em Enfermagem, Universidade Federal do Paraná, Curitiba, PR, Brazil
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Young LK, Mansfield B, Mandoza J. Nursing Care of Adult Hematopoietic Stem Cell Transplant Patients and Families in the Intensive Care Unit. Crit Care Nurs Clin North Am 2017; 29:341-352. [DOI: 10.1016/j.cnc.2017.04.009] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
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Langer S, Lehane C, Yi J. Patient and Caregiver Adjustment to Hematopoietic Stem Cell Transplantation: a Systematic Review of Dyad-Based Studies. Curr Hematol Malig Rep 2017; 12:324-334. [DOI: 10.1007/s11899-017-0391-0] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/22/2023]
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Hall A, Lynagh M, Carey M, Sanson-Fisher R, Mansfield E. Who are the support persons of haematological cancer survivors and how is their performance perceived? Psychooncology 2017; 26:2201-2207. [DOI: 10.1002/pon.4449] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/19/2016] [Revised: 04/10/2017] [Accepted: 04/27/2017] [Indexed: 11/11/2022]
Affiliation(s)
- Alix Hall
- Priority Research Centre for Health Behaviour, Faculty of Health; The University of Newcastle; Callaghan NSW Australia
- Hunter Medical Research Institute; New Lambton Heights NSW Australia
| | - Marita Lynagh
- Priority Research Centre for Health Behaviour, Faculty of Health; The University of Newcastle; Callaghan NSW Australia
- Hunter Medical Research Institute; New Lambton Heights NSW Australia
| | - Mariko Carey
- Priority Research Centre for Health Behaviour, Faculty of Health; The University of Newcastle; Callaghan NSW Australia
- Hunter Medical Research Institute; New Lambton Heights NSW Australia
| | - Rob Sanson-Fisher
- Priority Research Centre for Health Behaviour, Faculty of Health; The University of Newcastle; Callaghan NSW Australia
- Hunter Medical Research Institute; New Lambton Heights NSW Australia
| | - Elise Mansfield
- Priority Research Centre for Health Behaviour, Faculty of Health; The University of Newcastle; Callaghan NSW Australia
- Hunter Medical Research Institute; New Lambton Heights NSW Australia
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Bevans M, El-Jawahri A, Tierney DK, Wiener L, Wood WA, Hoodin F, Kent EE, Jacobsen PB, Lee SJ, Hsieh MM, Denzen EM, Syrjala KL. National Institutes of Health Hematopoietic Cell Transplantation Late Effects Initiative: The Patient-Centered Outcomes Working Group Report. Biol Blood Marrow Transplant 2017; 23:538-551. [PMID: 27660168 PMCID: PMC5346334 DOI: 10.1016/j.bbmt.2016.09.011] [Citation(s) in RCA: 90] [Impact Index Per Article: 12.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/07/2016] [Accepted: 09/12/2016] [Indexed: 12/20/2022]
Abstract
In 2015, the National Institutes of Health convened six working groups to address the research needs and best practices for late effects of hematopoietic stem cell transplantation survivors. The Patient-Centered Outcomes Working Group, charged with summarizing the HRQOL evidence base, used a scoping review approach to efficiently survey the large body of literature in adult and pediatric HCT survivors over 1 year after transplantation. The goals of this paper are to (1) summarize the current literature describing patient-centered outcomes in survivors, including the various dimensions of health-related quality of life affected by HCT, and describe interventions tested to improve these outcomes; (2) highlight areas with sufficient evidence allowing for integration into standard practice; (3) address methodological issues that restrict progress in this field; (4) identify major gaps to guide future research; and (5) specify priority research recommendations. Patient-centered outcomes were summarized within physical, psychological, social, and environmental domains, as well as for adherence to treatment, and health behaviors. Interventions to improve outcomes were evaluated for evidence of efficacy, although few interventions have been tested in long-term HCT survivors. Methodologic issues defined included lack of consistency in the selection of patient-centered outcome measures, along with the absence of a standard for timing, frequency, and mode of administration. Recommendations for HCT survivorship care included integration of annual screening of patient-centered outcomes, use of evidence-based practice guidelines, and provision of treatment summaries and survivorship care plans after HCT. Three priority research recommendations included the following: (1) design and test risk-targeted interventions with dose-intensity modulation matching the needs of HCT survivors with priority domains, including sexual dysfunction, fatigue, sleep disruption, nonadherence to medications and recommended health care, health behaviors including physical inactivity and healthy eating, and psychological dysfunction, with particular consideration of novel technologies to reach HCT survivors distant from their transplantation centers; (2) design a consensus-based methodologic framework for outcomes evaluation; and (3) evaluate and compare existing practices for integrating patient-centered outcome screening and interventions across HCT survivorship programs.
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Affiliation(s)
- Margaret Bevans
- Nursing Department, National Institutes of Health Clinical Center, Bethesda, Maryland.
| | - Areej El-Jawahri
- Department of Medicine, Massachusetts General Hospital, Boston, Massachusetts
| | - D Kathryn Tierney
- Division of Primary, Preventive and Community Medicine, Stanford University, Stanford, California
| | - Lori Wiener
- Psychosocial Support and Research Program, Center for Cancer Research, National Cancer Institute, Bethesda, Maryland
| | - William A Wood
- Division of Hematology and Oncology, University of North Carolina, Durham, North Carolina
| | - Flora Hoodin
- Department of Psychiatry, University of Michigan & Department of Psychology, Eastern Michigan University, Ann Arbor, Michigan
| | - Erin E Kent
- Division of Cancer Control and Population Sciences, National Cancer Institute, Bethesda, Maryland
| | - Paul B Jacobsen
- Psychosocial and Palliative Care Program, Moffitt Cancer Center, Tampa, Florida
| | - Stephanie J Lee
- Clinical Research Division, Fred Hutchinson Cancer Research Center, Seattle, Washington
| | - Matthew M Hsieh
- Molecular and Clinical Hematology Branch, National Institutes of Health, National Heart Lung and Blood Institute, Bethesda, Maryland
| | - Ellen M Denzen
- National Marrow Donor Program/Center for International Blood and Marrow Transplant Research, Minneapolis, Minnesota
| | - Karen L Syrjala
- Clinical Research Division, Fred Hutchinson Cancer Research Center, Seattle, Washington
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Bergkvist K, Larsen J, Johansson UB, Mattsson J, Fossum B. Family members' life situation and experiences of different caring organisations during allogeneic haematopoietic stem cells transplantation-A qualitative study. Eur J Cancer Care (Engl) 2016; 27. [PMID: 27859940 DOI: 10.1111/ecc.12610] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 10/24/2016] [Indexed: 11/30/2022]
Abstract
The aim of this study was to describe family members' life situation and experiences of care in two different care settings, the patient's home or in hospital during the acute post-transplantation phase after allogeneic haematopoietic stem cell transplantation (HSCT). Data were collected through semi-structured interviews with 14 family members (seven women and seven men). An inductive qualitative content analysis was used to analyse the data. The majority of the family members' (n = 10) had experiences from home care. The findings show the family members' voice of the uncertainty in different ways, related with the unknown prognosis of the HSCT, presented as Being me being us in an uncertain time. The data are classified into; To meet a caring organisation, To be in different care settings, To be a family member and To have a caring relationship. Positive experiences such as freedom and security from home care were identified. The competence and support from the healthcare professionals was profound. Different strategies such as adjusting, having hope and live in the present used to balance to live in an uncertain time. The healthcare professionals need to identify psychosocial problems, and integrate the psychosocial support for the family to alleviate or decrease anxiety during HSCT, regardless of the care setting.
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Affiliation(s)
| | - J Larsen
- The Red Cross University College, Stockholm, Sweden
| | - U-B Johansson
- Sophiahemmet University, Stockholm, Sweden.,Department of Clinical Sciences and Education, Södersjukhuset, Karolinska Institutet, Stockholm, Sweden
| | - J Mattsson
- Center for Allogeneic Stem Cell Transplantation, Karolinska University Hospital, Huddinge, Stockholm, Sweden.,Department of Oncology and Pathology, Karolinska Institutet, Stockholm, Sweden
| | - B Fossum
- Sophiahemmet University, Stockholm, Sweden.,Department of Clinical Sciences and Education, Södersjukhuset, Karolinska Institutet, Stockholm, Sweden
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Raj M, Choi SW, Platt J. A qualitative exploration of the informed consent process in hematopoietic cell transplantation clinical research and opportunities for improvement. Bone Marrow Transplant 2016; 52:292-298. [PMID: 27748736 DOI: 10.1038/bmt.2016.252] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/31/2016] [Revised: 07/29/2016] [Accepted: 08/06/2016] [Indexed: 11/09/2022]
Abstract
Informed consent (IC) struggles to meet the ethical principles it strives to embody in the context of hematopoietic cell transplantation (HCT). Patients often participate in multiple clinical trials making it difficult to effectively inform the participants and fulfill complex regulations. The recent Notice of Proposed Rule Making would make major changes to federal requirements, providing a timely opportunity to evaluate existing practice. Twenty health care professionals within a Midwest Academic Medical Center involved in obtaining IC in the HCT clinic or involved in patient care during or after the IC process were interviewed to understand: (1) how they approached the IC process; (2) how they described a 'successful' IC process; and (3) opportunities for innovation. Narrative and discourse analyses of interviews indicate that providers understand IC to be a collaborative process requiring engagement and participation of providers, patients and caregivers. 'Markers of success' were identified including cognitive, affective and procedural markers focusing on patient understanding and comfort with the decision to participate. Opportunities for innovating the process included use of decision aids and tablet-based technology, and better use of patient portals. Our findings suggest specific interventions for the IC process that could support the process of consent for providers, patients and caregivers.
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Affiliation(s)
- M Raj
- Department of Learning Health Sciences, University of Michigan Medical School, Ann Arbor, MI, USA
| | - S W Choi
- Blood and Marrow Transplantation Program, Department of Pediatrics, University of Michigan Medical School, Ann Arbor, MI, USA
| | - J Platt
- Department of Learning Health Sciences, University of Michigan Medical School, Ann Arbor, MI, USA
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