Transcript The example of bone marrow transplantation Hildegard Greinix Medical University of Vienna, Austria

Empowering hospital patients as partners in their diagnosis and treatment
The example of bone marrow
transplantation
Hildegard Greinix
Medical University of Vienna, Austria
Who needs a marrow or blood
stem cell transplant?
• Patients with leukemia, lymphoma and
rapidly growing tumors
• Patients with serious damage of marrow or
immunodeficiencies
• Sometimes very ill individuals with no other
treatment options
• Preemptive SCT in individuals in excellent
condition without disease to prevent relapse
Outcome of AML patients after unrelated donor
HSCT with myeloablative conditioning
100
CR1
OS
60
CR2/3
40
TRM
20
TRM
Probability in [%]
80
Refractory
0
0
19.04.2004
24
48
72
Months after HSCT
96
120
Marrow and Blood Stem Cell
Transplantation
Decision to Transplant
Referring
physician
BMT Attending
Patient
Relatives
• Information on procedures, risks, benefits,
long-term side effects, rehabilitation
• Counceling by physicians, nurses, psychologist
• Information from former patients
• Visit of the BMT unit
Psychosocial aspects - the patient
prior to SCT
• Pressure: deadly disease, high cure by SCT
but potentially lethal side effects.
• Fear of finding no suitable donor.
• Psychosocial morbidity, depression, anxiety
frequent.
• Coping mechanisms: fighting spirit,
hopelessness, helplessness (affect survival).
INTERDISCIPLINARY PSYCHOSOCIAL
SUPPORT AND THERAPY DURING SCT
Pre-SCT
In-Hospital
Treatment
Visit of the SCT Unit
Informed Consent
Compliance with therapy
Outpatient Care
Prepare discharge
Psychosocial support
Physicians, nurses,
psychologist
Support by physicians,
nurses, psychologist
- Provide information
- Evaluate ressources and
coping strategies, areas with
potential problems, social
support
- Counceling
- Provide information,
education
- Support by team
- Integration of family
- Close cooperation of staff
and patient
If indicated
Psychologic evaluation,
prevention, therapy
Psycholog. interventions for
anxiety, depression
Support of rehabilitation
Continuous medical care
Nursing care if necessary
Psychologic/psychotherapeutic support
Physiotherapy
If indicated: Socialworker, Pastor, Consulting psychiatrist
Information and education to ensure compliance with therapy
Support in dealing with fear, hopelessness, helplessness, isolation
Concept of Psychosocial Care
MUW
Physiotherapy
Socialwork
BMT
Physicians
Spiritual
welfare
Patient
Nursing staff
Psychologist
Consulting
psychiatrist
Dietician
Psychosocial aspects – the
patient during SCT
- Anxiety
- Loss of control
- Social Isolation
- Pain, nausea, fever
Psychosocial Support by the
Whole Team
- Stable working alliance on
the basis of trust
- Open and comprehensible
information on an individual basis
- Supporting the patient emotionally
- Counterbalancing the feeling of loss
of control
- Counterbalancing the feeling of
isolation
- Allow privacy as much as possible
Psychosocial aspects - the
transplant team
• Psychosocial well-being of team members
– Dominance of technology, rapidity of decision
making and practice. Excessive responsibilities.
– Highly demanding patients and families.
– Highly motivated patients at admission, in case
of complications terrible deaths with intensivecare interventions: patients dy of therapy, guilt.
– In case of prolonged stress: illness,
productivity, high turn-over
Psychosocial aspects - the
transplant team
• Care for/of the team
– Increased communication among team
members
– Weekly discussions of work with patients with
psychologist on voluntarily basis
– Psycho-oncological training
– Standardization of procedures and
documentation
– Labour and time consuming effort
Marrow and Blood Stem Cell
Transplantation
Psychosocial aspects - the patient
in the outpatient clinic
• Disappointment over fatigue, high susceptibility to
infections and slow return to normal life.
•  anxiety and depression prior to SCT predict 
anxiety and depression after SCT.
• Problems in long-term: infertility, fear of relapse
and secondary malignancies, job loss.
• Realistic and detailed information from staff about
lengthy rehabilitation periods: frustration about
shortcomings in working and social roles.
INTERDISCIPLINARY PSYCHOSOCIAL
SUPPORT AND THERAPY DURING SCT
Pre-SCT
In-Hospital
Treatment
Visit of the SCT Unit
Informed Consent
Compliance with therapy
Outpatient Care
Prepare discharge
Psychosocial support
Physicians, nurses,
psychologist
Support by physicians,
nurses, psychologist
- Provide information
- Evaluate ressources and
coping strategies, areas with
potential problems, social
support
- Counceling
- Provide information,
education
- Support by team
- Integration of family
- Close cooperation of staff
and patient
If indicated
Psychologic evaluation,
prevention, therapy
Psycholog. interventions for
anxiety, depression
Support of rehabilitation
Continuous medical care
Nursing care if necessary
Psychologic/psychotherapeutic support
Physiotherapy
If indicated: Socialworker, Pastor, Consulting psychiatrist
Information and education to ensure compliance with therapy
Support in dealing with fear, hopelessness, helplessness, isolation
What do we gain with our
concept?
•  post traumatic stress disorder
•  quality of life in HSCT recipients
•  patient compliance due to information and
education over lengthy times of recovery
•  satisfaction and quality of work for all
staff members due to improved
communication and cooperation