Changes in the health care system have resulted in shifting a significant portion of care to the home environment where patients are responsible for care previously given by nurses in the acute care setting. This shift is especially evident in hematopoietic cell transplant (HCT) patients who have life-threatening disease and treatment and are acutely ill for months after hospital discharge. It is to this population that the advanced practice nurse (APN) can bring considerable knowledge and skill. The overall goal of this research is to improve outcomes for patients undergoing HCT by testing a Standardized Nursing Intervention Protocol for HCT Patients that integrates interdisciplinary patient teaching content. The study aims and hypotheses are to:
Aim 1. Test the effects of a Standardized Nursing Intervention Protocol (SNIP) on overall QOL, (physical, psychological, social and spiritual well-being) and functional status for allogeneic HCT patients at discharge, 3, 6, and 12 months post hospitalization as compared to allogeneic patients who receive usual care plus attention control.
Aim 2 : Test the effects of SNIP-HCT on secondary outcomes of time-to-first complication, total number of complications, and mortality across groups.
Aim 3 : Identify subgroups of patients who benefit most from the SNIP-HCT in relation to sociodemographic characteristics, disease and clinical factors, and transplant factors.
Aim 4 : Decompose the effect on the SNIP-HCT on QOL into direct and indirect effects This Phase II study is designed as a longitudinal single blind, randomized clinical trial for allogeneic HCT patients. The framework includes an adaptation of McCorkle's SNIP approach, expanded to a population with numerous and persistent physical problems, as well as psychosocial and spiritual challenges. A total of 352 eligible HCT patients will be randomized to the SNIP-HCT or an attention control group. The six session teaching content for the experimental group is given by an advanced practice nurse in consultation with an interdisciplinary advisory committee. The experimental group receives multiple home visits and telephone calls for teaching and follow-up by an APN. Outcomes are evaluated at 3, 6 and 12 months post hospital discharge. The study builds on over ten years of research collaboration with an interdisciplinary HCT team. ? ?

Agency
National Institute of Health (NIH)
Institute
National Cancer Institute (NCI)
Type
Research Project (R01)
Project #
1R01CA107446-01A2
Application #
7048163
Study Section
Nursing Science: Adults and Older Adults Study Section (NSAA)
Program Officer
O'Mara, Ann M
Project Start
2006-03-06
Project End
2010-02-28
Budget Start
2006-03-06
Budget End
2007-02-28
Support Year
1
Fiscal Year
2006
Total Cost
$433,041
Indirect Cost
Name
City of Hope/Beckman Research Institute
Department
Type
DUNS #
027176833
City
Duarte
State
CA
Country
United States
Zip Code
91010
Grant, Marcia; Cooke, Liz; Williams, Anna Cathy et al. (2012) Functional status and health-related quality of life among allogeneic transplant patients at hospital discharge: a comparison of sociodemographic, disease, and treatment characteristics. Support Care Cancer 20:2697-704
Gemmill, Robin; Williams, Anna Cathy; Cooke, Liz et al. (2012) Challenges and strategies for recruitment and retention of vulnerable research participants: promoting the benefits of participation. Appl Nurs Res 25:101-7
Cooke, Liz; Grant, Marcia; Gemmill, Robin (2012) Discharge needs of allogeneic transplantation recipients. Clin J Oncol Nurs 16:E142-9
Gemmill, Robin; Cooke, Liz; Williams, Anna Cathy et al. (2011) Informal caregivers of hematopoietic cell transplant patients: a review and recommendations for interventions and research. Cancer Nurs 34:E13-21
Cooke, Liz; Chung, Carol; Grant, Marcia (2011) Psychosocial care for adolescent and young adult hematopoietic cell transplant patients. J Psychosoc Oncol 29:394-414
Cooke, Liz Diana; Gemmill, Robin; Grant, Marcia Lee (2011) Creating a palliative educational session for hematopoietic stem cell transplantation recipients at relapse. Clin J Oncol Nurs 15:411-7
Cooke, Liz; Grant, Marcia; Eldredge, Deborah H et al. (2011) Informal caregiving in Hematopoietic Blood and Marrow Transplant patients. Eur J Oncol Nurs 15:500-7
Cooke, Liz; Gemmill, Robin; Kravits, Kate et al. (2009) Psychological issues of stem cell transplant. Semin Oncol Nurs 25:139-50
Cooke, Liz; Gemmill, Robin; Grant, Marcia (2008) Advanced practice nurses core competencies: a framework for developing and testing an advanced practice nurse discharge intervention. Clin Nurse Spec 22:218-25