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 QOLinto direct and indirect effects This Phase II study is designed as alongitudinal single blind, randomized clinical trial for allogeneic HCT patients. Theframework includes an adaptation ofMcCorkle's SNIP approach, expanded to apopulation with numerous andpersistent physicalproblems, as well as psychosocial and spiritual challenges. A total of 352 eligible HCTpatients will be randomized to the SNIP-HCT or an attention control group. Thesix session teaching content for the experimental group is given by an advancedpractice nurse in consultation with an interdisciplinary advisory committee. Theexperimental group receives multiple home visits and telephone calls for teaching and follow-up by an APN. Outcomes are evaluated at 3,6 and 12months post hospital discharge. Thestudy builds on over ten years of research collaboration with an interdisciplinary HCT team.
