Herrmann R P, Leather M, Leather H L, Leen K
Division of Cancer Services, Royal Perth Hospital, Australia.
Oncol Nurs Forum. 1998 Sep;25(8):1427-32.
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.
Descriptive, cross-sectional, qualitative.
Patients' homes within the metropolitan area of Perth, Australia.
25 Caucasian adults with recurrent multiple myeloma, non-Hodgkin's lymphoma, or Hodgkin's disease requiring autologous HSCT.
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.
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.
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.
Participation in the home transplant program, patient satisfaction, nursing development, and cost-effectiveness of the program.
目的/目标：开展一项在患者家中进行自体造血干细胞移植（HSCT）的试点研究，以提高护理满意度、降低财务成本并缓解住院床位压力。
描述性、横断面、定性研究。
澳大利亚珀斯大都市区内的患者家中。
25名患有复发性多发性骨髓瘤、非霍奇金淋巴瘤或霍奇金病且需要进行自体HSCT的白种成年人。
制定了一项计划，利用一家大型三级医院的骨髓移植团队进行家访、在家进行细胞毒性化疗、在家治疗并发症，并设立一个家庭/医院综合护理设施，以便在出现并发症时加快住院治疗。
该计划实施起来切实可行，提高了患者总体满意度，且成本显著低于住院移植。在25名研究对象组成的总研究组中，有15名患者（60%）因并发症（主要是发热性中性粒细胞减少症）需要住院，中位住院时间为5天（范围为1 - 13天）。25名患者中有19名（76%）在中性粒细胞减少期间在家接受了静脉抗生素治疗。两名患者死于移植相关并发症——一名死于呼吸道合胞病毒感染，一名死于肝静脉闭塞病。这些并发症并非由家庭环境导致。
该计划增加了高级实践护士的责任感和自主意识，培养了他们的咨询技能以及更积极参与相关人员决策过程的能力。
参与家庭移植计划、患者满意度、护理发展以及该计划的成本效益。
