Clinical care for patients receiving autologous hematopoietic stem cell transplantation in the home setting.

PURPOSE/OBJECTIVES: To undertake a pilot study of autologous hematopoietic stem cell transplantation (HSCT) in the patient's home to improve satisfaction of care, reduce financial costs, and relieve pressure on inpatient accommodation.

DESIGN

Descriptive, cross-sectional, qualitative.

SETTING

Patients' homes within the metropolitan area of Perth, Australia.

SAMPLE

25 Caucasian adults with recurrent multiple myeloma, non-Hodgkin's lymphoma, or Hodgkin's disease requiring autologous HSCT.

METHODS

A program was developed to use the bone marrow transplant team from a major tertiary hospital to permit home visiting, treatment with cytotoxic chemotherapy at home, treatment of complications at home, and an integrated home/hospital caring facility to expedite hospital admission if complications developed.

FINDINGS

The program was practical to administer, improved overall patient satisfaction, and was significantly less costly than inpatient transplantation. Fifteen patients (60%) of the total study group of 25 required hospital admission for a median of five days (range 1-13 days) for management of complications, predominantly febrile neutropenia. Nineteen (76%) of the 25 patients received i.v. antibiotic therapy at home during the period of neutropenia. Two patients died of transplant-related complications--one from respiratory syncytial virus infection and one from veno-occlusive disease of the liver. These complications were not attributable to the home setting.

IMPLICATIONS FOR NURSING PRACTICE

This program increased the responsibility and sense of autonomy of advanced practice nurses and developed their counseling skills as well as their ability to participate more actively in the decision-making process of those involved.

MAIN RESEARCH VARIABLES

Participation in the home transplant program, patient satisfaction, nursing development, and cost-effectiveness of the program.