Clinical care for patients receiving autologous hematopoietic stem cell transplantation in the home setting

Abstract

Purpose/objectives: To undertake a pilot study of autologous hematopoietic stem cell transplantation (HSCT) in the patient's home to improve satisfaction of care, reduce financial costs, and relieve pressure on inpatient accommodation.

Design: Descriptive, cross-sectional, qualitative.

Setting: Patients' homes within the metropolitan area of Perth, Australia.

Sample: 25 Caucasian adults with recurrent multiple myeloma, non-Hodgkin's lymphoma, or Hodgkin's disease requiring autologous HSCT.

Methods: A program was developed to use the bone marrow transplant team from a major tertiary hospital to permit home visiting, treatment with cytotoxic chemotherapy at home, treatment of complications at home, and an integrated home/hospital caring facility to expedite hospital admission if complications developed.

Findings: The program was practical to administer, improved overall patient satisfaction, and was significantly less costly than inpatient transplantation. Fifteen patients (60%) of the total study group of 25 required hospital admission for a median of five days (range 1-13 days) for management of complications, predominantly febrile neutropenia. Nineteen (76%) of the 25 patients received i.v. antibiotic therapy at home during the period of neutropenia. Two patients died of transplant-related complications--one from respiratory syncytial virus infection and one from veno-occlusive disease of the liver. These complications were not attributable to the home setting.

Implications for nursing practice: This program increased the responsibility and sense of autonomy of advanced practice nurses and developed their counseling skills as well as their ability to participate more actively in the decision-making process of those involved.

Main research variables: Participation in the home transplant program, patient satisfaction, nursing development, and cost-effectiveness of the program.