Bone marrow and stem cell transplantation can be a challenging procedure for patients and their families—not only during the process, but also after patients go home.
After weeks of recovery in the safety of City of Hope’s bone marrow transplant unit, patients may be overwhelmed about all the details they need to know, from managing medications, diet and fluid intake to monitoring their symptoms.
Many answers can be found within the pages of written guides provided to patients as they prepare to go home after hematopoietic cell transplantation. But as those in the Department of Nursing Research & Education know, patients do not necessarily hear or understand the message.
“One-on-one teaching, though, through a personalized scientifically based nurse consultation, can be a very effective approach to assisting patients,” said Marcia Grant, R.N., D.N.Sc., director of the Department of Nursing Research & Education.
That is why the nursing research group is conducting the Standard Nursing Intervention Protocol, or SNIP, an experimental study that tests whether an educational program conducted by an advanced practice nurse can improve transplant patients’ quality of life.
“The first intervention takes place just before a patient is discharged, then five additional sessions are done at a patient’s home or the clinic,” Grant said. “Each session is done individually, two to three weeks apart, and an oncology advanced practice nurse works directly with the patient.” The nurse essentially becomes a coach for both patient and family and is available to answer questions and discuss issues.
What makes the protocol unique is its focus on all aspects of a cancer survivor’s life, not just immediate physical needs.
The first session focuses on immediate practical issues, Grant said, including gathering important details such as emergency telephone numbers.
The second visit gets into physical well-being: preventing dehydration, getting proper nutrition, safely living with children and pets and avoiding infection, handling fatigue and similar matters. On the third visit, however, the nurse moves into other aspects of life. Psychological issues, such as coping with emotions, being aware of depression and handling anxiety, are all key for survivors.
Social well-being, such as maintaining family relationships, balancing finances and adapting to work situations, all come up in the fourth session, while the fifth deals with spiritual well-being— getting meaning from life.
By the last session, the nurse says goodbye and gently eases the patient into the post-cancer world. “It’s about getting on with your life. You’re in charge now,” Grant said.
Grant noted that a separate, control group of patients enrolled in the study do not receive the educational program but have 100-day access to a 24-hour telephone help line staffed by an expert nurse. Researchers will compare outcomes of the patients in the education arm of the study to those in the control arm.
Advanced practice nurse Liz Cooke, N.P., M.S.N., R.N., has worked with 21 patients so far, Grant said. Pharmaceutical company Amgen supported the study through its first 18 patients. The National Cancer Institute now funds the four-year study, which aims to accrue 300 patients, through an R01 grant.
The study is modeled on a program conducted at Yale University for elderly patients discharged from surgery. “If this program proves successful,” Grant said, “we hope this education will be rolled into part of normal care here.”