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Implementation and evaluation of a nurse-allied health clinic for patients after haematopoietic stem cell transplantation

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Abstract

Purpose

Patients who undergo haematopoietic stem cell transplantation (HSCT) often have multiple health issues following hospital discharge. In many centres, outpatient follow-up is solely conducted by specialist physicians. We aimed to implement and describe the outcomes of a nurse-allied health multidisciplinary clinic.

Methods

The clinic consisted of six disciplines—nursing, pharmacy, dietetics, physiotherapy, occupational therapy and social work. All allogeneic and high risk autologous HSCT patients were reviewed at 2 weeks after discharge and on day 100 post HSCT, with additional reviews as needed. Occasions of service, interventions, readmission data and physician satisfaction survey were collected prior to and after implementation. Additionally, patient feedback and quality of life survey (FACT-BMT) were collected during the first 6 months.

Results

From July to December 2019, 57 patients were reviewed in the clinic (475 reviews, average 8.3 reviews per patient). Common interventions included the following: exercise programs by physiotherapist (n = 111), diet prescription (n = 103), counselling by social worker (n = 53), medication lists provision (n = 51), fatigue management (n = 43) and nurse education (n = 22). The clinic did not reduce patients’ readmission rate; however, positive feedback from patients and physicians were reported. FACT-BMT results demonstrated that there are unmet needs, particularly fatigue management, sexual education and support, body images, back to work support and quality of life improvement. From discharge to day 100, there was no significant improvement in quality of life.

Conclusions

This clinic provides an innovative approach to patient-centred care in HSCT. It has been well received by patients who were supported by multidisciplinary interventions.

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Data availability

All data is available on request.

Code availability

Not applicable.

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Acknowledgements

This project received the Metro North SEED Grant in 2019. We acknowledge all patients who participated in the study. We would also like to acknowledge Cancer Care Services, Allied Health and Pharmacy at the Royal Brisbane and Women’s Hospital. We acknowledge Bone Marrow Transplant specialist physicians and registrars.

Funding

This project was financially supported by Metro North SEED Grant (Queensland Health).

Author information

Authors and Affiliations

Authors

Contributions

All authors contributed to the study conception and design. Material preparation, data collection and analysis were performed by all authors. The first draft of the manuscript was written by Midori Nakagaki, and comments on subsequent versions of the manuscript were made by Nicole Gavin and Glen Kennedy. All authors read and approved the final manuscript.

Corresponding author

Correspondence to Midori Nakagaki.

Ethics declarations

Ethics approval

This study was approved by Royal Brisbane &Women’s Hospital Human Research Ethics Committee (LNR/2019/QRBH/52748).

Consent to participate

As this study was a quality improvement project, participants’ consent was waived.

Consent for publication

Not applicable as consent was waived and no patient data or individual data was included in manuscript.

Conflicts of interest

The authors declare no competing interests.

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This work was presented at the following conferences: 27/11/2019 Brisbane Cancer Conference, Brisbane, Australia; 21–22/11/2020 The Society of Hospital Pharmacists of Australia National Conference, Virtual, Australia; 18–19/03/2021 Cancer Survivorship Annual Conference, Virtual, Australia; 14–17/03/2021 European Blood and Marrow Transplant (EBMT) Annual Meeting, Virtual; 11-13/07/2021 The Dietitians Australia 2021 Conference, Virtual, Australia; and 24–26/06/2021 MASCC/ISOO 2021 Annual Meeting, Virtual

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Nakagaki, M., Gavin, N.C., Hayes, T. et al. Implementation and evaluation of a nurse-allied health clinic for patients after haematopoietic stem cell transplantation. Support Care Cancer 30, 647–657 (2022). https://doi.org/10.1007/s00520-021-06461-w

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