Managing the Mental Distress of the Hematopoietic Stem Cell Transplant (HSCT) Patient: a Focus on Delirium

Consultation models in psychosocial oncology

PURPOSE

Best practice regarding screening for cancer-related distress includes timely follow-up with psychosocial services to address identified needs. Cancer centers frequently struggle to identify distress via systematized, low-burden workflows and link patients to high-quality, evidenced-based care. Models of psychological and psychiatric consultation can address several known challenges of attending to patient and provider need and can be designed with varying resources and levels of integration. Consultation can be offered in inpatient and outpatient settings and function independently or within existing supportive care departments.

METHODS

This review summarizes four models of consultation including 1) inpatient psychological consultation, 2) outpatient psychological consultation, 3) integrated and tiered psychiatric consultation, and 4) integration of behavioral health providers into subspecialty teams. We present data on utilization of each model, as well as patient clinical outcomes and satisfaction measures and provider satisfaction.

RESULTS

Consultation models are utilized and offer an effective approach to optimizing timely and accessible care. Utilizing this model of care between July 2020 and June 2021, we managed more than 1200 inpatient referrals for consultation and responded to more than 1600 outpatients with positive distress screens. Programs should consider strengths and limitations of implementing consultation models, with an emphasis on available staffing and institutional investment in supportive care for cancer survivors.

Survival protection of patients undergoing hematopoietic stem cell transplantation: grounded theory

PURPOSE

For patients with blood malignancies, hematopoietic stem cell transplantation (HSCT) is a significant challenge. These patients have hope to be completely cured after the transplantation, but deal with the dread of dying at the same time. This study presents a deep understanding of the psychological process of the treatment including perception, emotion, interactions, and its consequences in patients undergoing HSCT.

METHODS

This study utilized a qualitative method based on the Strauss and Corbin Approach toward the grounded theory. The research population comprised all patients undergoing HSTC in Taleghani Hospital (Tehran, Iran) who were able to communicate effectively. The data were collected through deep and unstructured interviews with consenting patients. The sampling started with a purposive method and continued until the theoretical saturation was met. The 17 participants were interviewed individually and the data were analyzed via Strauss and Corbin Approach (2015).

RESULTS

According to the findings of the present study, the threat to survival was the main concern of patients during the transplant process. The patients tried to cope with the threat to survival through strategies that were conceptualized as survival protection. These strategies led to the consequences such as debris removal and fondness for life, through which the patients rebuilt themselves, while on the alert for transplant rejection.

CONCLUSION

The results suggested that dealing with HSCT affects personal and social aspects of a patient's life. This means, taking measures to facilitate psychological affairs and financial expenses, increasing the nursing manpower, and helping patients to reduce tension play a vital role to improve their fighting spirit.

Understanding the symptom experience and self-management strategies of adult hematopoietic stem cell transplantation patients during hospitalization: findings from a qualitative longitudinal study

PURPOSE

The aim of this study was to explore the symptom experience and self-management strategies of adult hematopoietic stem cell transplantation patients during hospitalization.

METHODS

This was a qualitative descriptive study. A heterogeneous sample of 19 patients who underwent hematopoietic stem cell transplantation from May to October 2021 were enrolled in the study. Semi-structured interviews were conducted at four time points during hospitalization, providing a total of 64 interview datasets.

RESULTS

Four themes and 11 subthemes reflecting the symptom experience and self-management strategies of adult hematopoietic stem cell transplantation patients during hospitalization were observed. The four themes were (1) unexpected symptom burden: dynamic, disturbing, co-occurring, and correlative; (2) emotional complexity at different periods; (3) internal predicament: ineffectiveness of symptom management; and (4) external strength: desire for support from multiple sources. Hematopoietic stem cell transplantation patients experienced a complex and dynamic array of symptoms from admission to discharge, and they experienced the dual forces of internal predicament and external strength in symptom self-management during hospitalization.

CONCLUSION

The findings of this study emphasize the need for a deeper understanding and precise management of the symptom experience of adult hematopoietic stem cell transplantation patients during hospitalization. Hematopoietic stem cell transplantation nurses need to assess symptoms on an ongoing basis; educate patients on ways to perceive, express, and self-manage multiple symptoms; and develop patients' self-symptom management skills to enhance their symptom relief and quality of life.

Virtual Reality for Symptom Management in Patients Undergoing Hematopoietic Stem Cell Transplantation: A Quality Improvement Initiative

OBJECTIVES

To evaluate the effects of virtual reality (VR) on symptom distress, such as depression, anxiety, and pain, experienced by individuals receiving allogeneic hematopoietic stem cell transplantation.

SAMPLE & SETTING

20 participants aged 19-70 years (median age of 56.5 years) who were hospitalized in an academic setting received as many as two sessions of VR per week for two weeks.

METHODS & VARIABLES

Before and after each session, participants completed the revised Edmonton Symptom Assessment Scale (ESAS-r) to evaluate their symptoms. Paired t tests were later conducted.

RESULTS

VR sessions showed significant improvement in 8 of the 10 symptoms addressed in ESAS-r.

IMPLICATIONS FOR NURSING

VR can improve symptoms in patients following hematopoietic stem cell transplantation in a hospital setting, provide a low-cost intervention to treat symptoms, and support future investigations exploring how VR affects prolonged hospitalizations related to distressing symptoms.

Psychological Considerations in Hematopoietic Stem Cell Transplantation

BACKGROUND

In recent decades, advances in transplantation medicine, and improved posttransplant care have reduced morbidity and mortality from hematopoietic stem cell transplantations (HSCTs). However, patients undergoing HSCT report a high prevalence of psychological distress, which can negatively impact recovery, function, and health outcomes, including mortality and higher risk of graft vs. host disease. Appropriate assessment and management of these psychological symptoms lead to better engagement with treatment and a variety of superior health outcomes.

OBJECTIVE

We provide a narrative review of the psychological challenges that accompany HSCT and suggest management approaches to equip psychiatric consultants involved in the care of this patient population.

METHODS

We reviewed published work in PubMed, PsycInfo, and Scopus electronic databases on the common psychological challenges in HSCT, their vulnerability factors, as well as practical interventions for managing these challenges.

RESULTS

We outline the phases of the HSCT hospitalization and discuss common psychological challenges, such as depression, delirium, and post-traumatic stress reactions that accompany HSCT. We suggest an approach to psychiatric consults during the HSCT hospitalization and discuss practical interventions for managing psychological challenges in this population.

CONCLUSIONS

Though pharmacological and behavioral interventions have been successfully used to treat psychosocial challenges in HSCT, further research is needed to understand the optimal psychiatric assessment tools, treatment strategies, and the long-term psychiatric care needed to address psychiatric comorbidities in this growing patient population.