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Villegas E, Arruñada M, Casado MÁ, González S, Moreno-Martínez ME, Peñuelas MÁ, Torres AM, Sierra Y, Seguí MA. National expert consensus on home-administered oncologic therapies in Spain. Front Oncol 2024; 14:1335344. [PMID: 38434688 PMCID: PMC10905380 DOI: 10.3389/fonc.2024.1335344] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/11/2023] [Accepted: 01/12/2024] [Indexed: 03/05/2024] Open
Abstract
The diagnosis and treatment of cancer impose a significant emotional and psychological burden on patients, families, and caregivers. Patients undergo several interventions in a hospital setting, and the increasing number of patients requiring extended care and follow-up is driving the demand for additional clinical resources to address their needs. Hospital at Home (HaH) teams have introduced home-administered oncologic therapies that represent a new model of patient-centered cancer care. This approach can be integrated with traditional models and offers benefits to both patients and healthcare professionals (HCPs). Home-administered treatment programs have been successfully piloted globally, demonstrated as a preferred option for most patients and a safe alternative that could reduce costs and hospital burden. The document aims to establish the minimum recommendations for the home administration of oncologic therapies (ODAH) based on a national expert agreement. The expert panel comprised seven leading members from diverse Spanish societies and three working areas: clinical and healthcare issues, logistical and administrative issues, and economic, social, and legal issues. The recommendations outlined in this article were obtained after a comprehensive literature review and thorough discussions. This document may serve as a basis for the future development of home-administered oncologic therapy programs in Spain. .
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Affiliation(s)
| | - María Arruñada
- Pharmacoeconomics & Outcomes Research Iberia (PORIB), Madrid, Spain
| | | | - Sonia González
- Innovation in Clinical Pharmacy Research Group (i-FARMA-Vigo), Vigo, Spain
- Galicia Sur Health Research Institute (IIS Galicia Sur), Vigo, Spain
- University Hospital Complex of Vigo (SERGAS-UVIGO), Vigo, Spain
| | | | | | | | | | - Miguel Angel Seguí
- Parc Taulí Foundation, Barcelona, Spain
- Autonomous University of Barcelona, Barcelona, Spain
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Batlle A, Aldemira A, Agúndez B, Cabrera I, Esquerdo E, López S, Achotegui A, Villalón C, de Sevilla MF. Home hospitalization of the acute patient: a new approach to care. An Pediatr (Barc) 2023; 99:329-334. [PMID: 37932161 DOI: 10.1016/j.anpede.2023.08.015] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/20/2023] [Accepted: 08/07/2023] [Indexed: 11/08/2023] Open
Abstract
Pediatric hospitalization at home (HAH) aims to provide the patient and his family with an alternative to conventional hospitalization, safely and effectively, improving the quality of life of the patient and his family. The most frequent pathologies in HAH in pediatric acute patients are acute respiratory pathology and bacterial infections that require parenteral antibiotic therapy. The success of an acute patient home hospitalization program relies on the proper selection of patients and exhaustive training of caregivers, as well as good communication and coordination between the different services and levels of care involved.
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Affiliation(s)
- Astrid Batlle
- Unidad de Hospitalización Domiciliaria, Servicio de Pediatría, Hospital Sant Joan de Déu, Esplugues de Llobregat, Barcelona, Spain
| | - Andrea Aldemira
- Unidad de Hospitalización Domiciliaria, Servicio de Pediatría, Hospital Sant Joan de Déu, Esplugues de Llobregat, Barcelona, Spain
| | - Beatriz Agúndez
- Unidad de Hospitalización Domiciliaria. Servicio de Pediatría. Hospital Universitario Niño Jesús, Madrid, Spain
| | - Isabel Cabrera
- Unidad de Hospitalización Domiciliaria. Servicio de Pediatría. Hospital Universitario Niño Jesús, Madrid, Spain
| | - Elisenda Esquerdo
- Unidad de Hospitalización Domiciliaria, Servicio de Pediatría, Hospital Sant Joan de Déu, Esplugues de Llobregat, Barcelona, Spain
| | - Sandra López
- Unidad de Hospitalización Domiciliaria, Servicio de Pediatría, Hospital Sant Joan de Déu, Esplugues de Llobregat, Barcelona, Spain
| | - Ane Achotegui
- Unidad de Hospitalización Domiciliaria, Servicio de Pediatría, Hospital Sant Joan de Déu, Esplugues de Llobregat, Barcelona, Spain
| | - Carmen Villalón
- Unidad de Hospitalización Domiciliaria, Servicio de Pediatría, Hospital Sant Joan de Déu, Esplugues de Llobregat, Barcelona, Spain
| | - Mariona Fernández de Sevilla
- Unidad de Hospitalización Domiciliaria, Servicio de Pediatría, Hospital Sant Joan de Déu, Esplugues de Llobregat, Barcelona, Spain; Institut de Recerca Sant Joan de Déu, Universidad de Barcelona, Barcelona, Spain; Consorcio de Investigación Biomédica en Red de Epidemiología y Salud Pública (CIBERESP), Madrid, Spain.
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Orford R, Slater P, Spencer B, Giarola T, Nicholls W, Walker R, Foresto S, Bradford N. One Hundred Times Better, at Home in Our Own Beds: Implementation of Home Intravenous Hydration After Chemotherapy in Children With Cancer. JOURNAL OF PEDIATRIC HEMATOLOGY/ONCOLOGY NURSING 2023; 40:265-276. [PMID: 37017002 DOI: 10.1177/27527530221147880] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 04/06/2023]
Abstract
Background: Home-based cancer care offers new ways of delivering supportive therapies, including post-chemotherapy hydration, traditionally delivered in hospital settings. Understanding how programs are developed and how parents perceive managing care at home offers opportunities to improve services and experiences. Aim: To describe the implementation process and evaluation of a home intravenous hydration program for children with cancer and thus to provide practical information for future initiatives. Methods: Data were prospectively collected on clinical impact, safety indicators, and estimated costs; these were tabulated and analysed. Semi-structured interviews were undertaken with a subset of parents regarding their experience and analysed using content analysis. Results: Over 34 months, 21 children were eligible, and 16 parents were educated and assessed competent with providing home care. All 16 children received home hydration with a median of 5.5 days per child (IQR 6.65 days). This avoided 116 hospital bed-days and associated costs, at an estimated total value of USD $ 105,521, on average saving USD $ 910 per day and USD $ 6,596 per child. There were no adverse events reported, and no child required re-admission to hospital while receiving home hydration. Parents were overwhelmingly positive in their feedback about the program. Verbatim quotes were synthesized under one overarching theme-supporting normality promotes recovery. Conclusion: When adequately trained and well supported, parents highly value providing home-based care to their children. This offers opportunities to improve experiences and outcomes for children and families as well as reduce costs to health services, achieving clinical impact without reducing safety.
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Affiliation(s)
- Rebekah Orford
- Oncology Services Group, Queensland Children's Hospital, Children's Health Queensland Hospital, and Health Service, South Brisbane, Australia
| | - Penelope Slater
- Oncology Services Group, Queensland Children's Hospital, Children's Health Queensland Hospital, and Health Service, South Brisbane, Australia
| | - Brooke Spencer
- Oncology Services Group, Queensland Children's Hospital, Children's Health Queensland Hospital, and Health Service, South Brisbane, Australia
| | - Teghan Giarola
- Oncology Pharmacy, Queensland Children's Hospital, Children's Health Queensland Hospital, and Health Service, South Brisbane, Australia
| | - Wayne Nicholls
- Oncology Services Group, Queensland Children's Hospital, Children's Health Queensland Hospital, and Health Service, South Brisbane, Australia
| | - Rick Walker
- Queensland Youth Cancer Service, Queensland Children's Hospital, Children's Health Queensland Hospital, and Health Service, South Brisbane, Australia
| | - Steven Foresto
- Oncology Services Group, Queensland Children's Hospital, Children's Health Queensland Hospital, and Health Service, South Brisbane, Australia
| | - Natalie Bradford
- Cancer and Palliative Care Outcomes Centre at Centre for Children's Health Research and School of Nursing, Queensland University of Technology, South Brisbane, Australia
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Batlle A, Thió-Henestrosa S, Boada I, López S, Moya I, Fernández JC, de Sevilla MF, García-García JJ. Attending pediatric acutely ill patients at home: families' socioeconomic characterization, expectations, and experiences. BMC Pediatr 2022; 22:679. [PMID: 36418983 PMCID: PMC9684951 DOI: 10.1186/s12887-022-03724-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/24/2022] [Accepted: 10/31/2022] [Indexed: 11/25/2022] Open
Abstract
BACKGROUND SJD a Casa is an acute pediatric hospital-at-home program that was initiated in 2019. For a thorough understanding of acute pediatric homecare programs, an analysis of all related factors, including the medical, social, and economic aspects as well as the family's experience, is essential. However, no previous study has attempted a comprehensive evaluation of this topic in relation to a complex program such as ours (in terms of the diseases and treatments offered). In this study, we aimed to finely characterize the population that opts for pediatric homecare programs and obtain a thorough understanding of the families' needs, which will improve our understanding of the program and potentially reveal possible deficiencies. METHODS This prospective quantitative and qualitative study involved collection of ordinal data as well as statements made by the caregivers of patients undergoing homecare. A total of 372/532 families were asked to answer two independent questionnaires (preadmission and postadmission) that evaluated their socioeconomic characteristics; expectations and experiences; and factors influencing the preference for homecare. The results were presented as frequencies and comparisons (Fisher's exact test). RESULTS The families had an adequate social network and a less-than-expected workload, and most families responded that they would have repeated the experience despite the workload. The expectations regarding the caregiver's well-being at home were better than the actual situation, since some caregivers experienced anxiety or fear. The rating for homecare was better than that for the inpatient care offered before the homecare transfer. CONCLUSIONS Families included in the program were content with the homecare program and mostly responded that they would repeat the experience if needed. Although the duration of the program was short-term, some caregivers may experience symptoms of burnout like anxiety, which should be taken into consideration. Despite its limitations, this study offers the possibility of improving our service portfolio by focusing on vulnerable families' access to the program and the caregiver's risk of burnout.
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Affiliation(s)
- Astrid Batlle
- grid.411160.30000 0001 0663 8628Hospital Sant Joan de Déu, Barcelona, Spain
| | - Santiago Thió-Henestrosa
- grid.5319.e0000 0001 2179 7512Departament Informàtica, Matemàtica Aplicada i Estadística, University of Girona, Girona, Spain
| | - Imma Boada
- grid.5319.e0000 0001 2179 7512Graphics and Imaging Laboratory, University of Girona, Girona, Spain
| | - Sandra López
- grid.411160.30000 0001 0663 8628Hospital Sant Joan de Déu, Barcelona, Spain
| | - Isabel Moya
- grid.411160.30000 0001 0663 8628Hospital Sant Joan de Déu, Barcelona, Spain
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De Zen L, Del Rizzo I, Vendrametto V, Nicolardi F, Vaccher S, Dall'Amico R, Rabusin M, Barbi E, Passone E. Safety and Feasibility of Home Transfusions in Pediatric Palliative Care: A Preliminary Report. J Pain Symptom Manage 2022; 63:e246-e251. [PMID: 34619325 DOI: 10.1016/j.jpainsymman.2021.09.018] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/26/2021] [Revised: 09/22/2021] [Accepted: 09/27/2021] [Indexed: 11/28/2022]
Abstract
BACKGROUND While hematological symptoms are considered difficult to manage in a Pediatric Palliative Care setting, home may still represent a safe and convenient place for transfusions in patients with advanced malignancy or chronic conditions. This research focuses on the safety and feasibility of a home transfusion program. METHODS This is a case series of patients between 0 and 18 years diagnosed with advanced malignancy or incurable chronic conditions and eligible to Pediatric Palliative Care who received home platelet or packed red cell transfusions. For all patients, we recorded adverse events such as acute hemolytic reactions, allergic reactions, or any emergency condition requiring hospital admission, equipment failure, blood product transport or storage errors, errors in patient identification, and personnel safety issues. We explored parental satisfaction with a Likert-type questionnaire and short open questions. RESULTS We reviewed 101 transfusion procedures for six patients in Pediatric Palliative Care performed by the Regional Pediatric Palliative Care network between 2014 and 2020. We did not report any adverse effects. Families reported satisfaction and a sense of safety and positively evaluated the opportunity of having transfusion at home to minimize the disruption in everyday life. The cost analysis resulted in a consistent saving for the Regional Health System. CONCLUSION This study supports the safety and feasibility of home transfusion in Pediatric Palliative Care.
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Affiliation(s)
- Lucia De Zen
- Centre for Pediatric Palliative Care and Pain Therapy (L.D.Z.), Institute for Maternal and Child Health Burlo Garofolo, Trieste, Italy
| | - Irene Del Rizzo
- University of Trieste (I.D.R., V.V., F.N., E.B.), Trieste, Italy.
| | | | | | - Silvia Vaccher
- Home Pediatric Palliative Care and Pain Service (S.V., R.D.), Azienda Sanitaria Friuli Occidentale, Pordenone, Italy
| | - Roberto Dall'Amico
- Home Pediatric Palliative Care and Pain Service (S.V., R.D.), Azienda Sanitaria Friuli Occidentale, Pordenone, Italy
| | - Marco Rabusin
- Pediatric Oncology Division (M.R.), Institute for Maternal and Child Health Burlo Garofolo, Trieste, Italy
| | - Egidio Barbi
- University of Trieste (I.D.R., V.V., F.N., E.B.), Trieste, Italy; Pediatric Department (E.B.), Institute for Maternal and Child Health Burlo Garofolo, Trieste, Italy
| | - Eva Passone
- Pediatric Department (E.P.), Azienda Sanitaria Universitaria Friuli Centrale, Udine, Italy
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