THE NURSES GROUP ORAL SESSIONS
Oral Session 1 N001 CLABSI MANAGEMENT: EVIDENCE BASED MEASURES IN PEDIATRIC HEMATOLOGY/ONCOLOGY AND BMT PATIENTS H. M. Nayani*,1, M. Hazeem1, M. Dagamseh1 1 King Faisal Speacialist Hospital and Research Centre, riyadh, Saudi Arabia Introduction: Pediatric hematology/oncology and stem cell transplant patients are the most vulnerable population of developing Central Line Associated Blood Stream Infection (CLABSI). It prolongs the hospital stay, increases the cost of hospitalization, and morbidity and mortality rate of the pediatric patient. Objective: To decrease the rate of CLABSI in bone marrow transplant unit by implementing evidence based strategies, policies and procedures Method: Plan, Do, Check, Act (PDCA) model and Centre of Disease Control (CDC) guidelines were implemented to analyze the roots of the increasing rates of CLABSI and to resolve it. A multidisciplinary team was formed including nurses, physicians, quality managements, products coordinator, and infection control. Training was provided to the nurses on hand hygiene, maintaining sterile technique and the implementation of the new products and practices like using of Chlorhexidine Gluconate (CHG) dressings and wipes, frequency of changing administration sets and adds on devices, and Central Venous Catheter (CVC) maintenance care. Results: The CLABSI rate signiﬁcantly falls from 4.10 to 2.26 per 1000 central line days from 2012-2014. In 2013 Q1, a wide range of ﬂuctuation seen with a sharp fall in Q2 2013. Then slightly increased by the end of the year. In the former part of this year, CLABSI rate rose signiﬁcantly and suddenly decrease below the benchmark (2.69) by the end of the Q2 2014. Conclusion: In summary, use of the multimodal approach to the central line access and care resulted in an overall reduction of the CLABSI rate that is 2.4 per 1000 central line days, over a period of 2 years below the National Health Service Corps (NHSC) parameter 2.69. Disclosure of Interest: None Declared.
chemotherapy planned (osmolarity, pH, risk of intimal injury and duration of chemotherapy). These variables have enabled the production of a decision algorithm which has been tested in a real population of 131 consecutive patients who had access to our day hospital between 01/01/2014 and 31/08/ 2014. Results: 5 of 131 patients (4%) began the treatment having previously placed a Port (PAC) or peripherally inserted central catheter (PICC), while 126 (96%) had central venous access. During chemotherapy, the PAC has been placed in 14 patients (11%) in the average distance from the start of chemotherapy of 27 days (5-84) and the PICC in 7 patients (5.5%) at a distance average of 55 days (0 -152). Analyzing the risk factors of their chemotherapy, 47 patients (36%) received therapy at risk for high osmolarity, 61 patients (47%) at risk for pH and 78 (60%) at risk for intimal damage. Of the 126 patients who started chemotherapy without central venous access, 73 have received treatment that would have required an infusion device for endovascular presence of at least one risk factor among the three evaluated on the basis of our algorithm, while 53 patients without factors risk should have been assessed on the basis of duration of chemotherapy. Among the 73 patients with at least one risk factor, only 18 (24%) were candidates for devices (13 PAC and 5 PICC); consequently 55 patients (76%) at risk of damage from chemotherapy have received treatment from peripheral venous access or by AVC placed and removed at each cycle. Of the 53 patients with no risk factors, however, 11 need a subcutaneous treatment—then come out from the observation; of the remaining 42 patients who required intravenous treatment, 27 were candidates to receive treatment lasting more than 4 weeks then, by algorithm, through peripheral access or midline, and 15 patients, lasting greater than or equal to 4 weeks, requiring a central access that has not been positioned. Conclusion: The use of a decision algorithm would be useful to identify, in advance, patients who may be at risk of damage from chemotherapy, allowing a programmation of the most appropriate device avoiding, when possible, an excessive number of placements of central venous catheters in urgency. In this way you can avoid multiple placements of AVC, reducing risks and costs. Disclosure of Interest: None Declared.
N002 THE STREETS OF AVC. ARE ENDLESS! A. Magaro’*,1, L. Orlando1, N. Frungillo1, F. Gigli1, D. Laszlo1, D. Infante Sosa1, A. Montanari1, L. Roveda2, A. Milani2, A. Piredda2, M. Milani2 1 Division of Clinical Haemato-Oncology, 2European Institute of Oncology, Milan, Italy
N003 TRANSPLANT UNIT PERSONNEL COMPETENCY MAINTANANCE ONLINE TESTING BY SHAREPOINT APPLICATION A. Babic*,1, L. Wannesson1, M. Trobia2, M. Lazzaro2 1 Transplant Unit, IOSI, 2Servizio qualita` e sicurezza dei pazienti, Ospedale Regionale Bellinzona e Valli & IOSI, Bellinzona, Switzerland
Introduction: The need of an adequate venous access is always a primary requirement for hematologic patients who must receive chemotherapy. In the last year the organization and the logistics of planning the placement of these devices was misleading and difﬁcult to manage with delays in the placement (and in some cases lack of placement) and consequent delay in treatment with long delays in hospitalization and burden on health care costs and patient compliance. Method: We have identiﬁed a number of clinical variables related to the patient (history, patient compliance, thrombotic diathesis, absence of peripheral venous access) and the type of
Introduction: FACT-JACIE International Standards Accreditation, Version 5 requires that the Clinical Program has access to personnel who are formally trained, experienced and competent in the management of patients receiving cellular therapy.Core competencies are speciﬁed within the standards and evidence of training in these competencies must be documented. This may be achieved by evidence of in service training, attendance at conferences etc. While initial supervised training is easily documented,annual competency maintenance can be difﬁcult to show. Ongoing training for clinical personnel should reﬂect their experience, individual
competencies and proﬁciencies, orientation for new staff and necessary preceptorships as such, training needs to be ﬂexible to reﬂect staff requirements. Training also needs to be done in a timely manner to demonstrate annual updating. We wanted to devise a system in order to facilitate both appropriate and timely demonstration of continuing competency within our transplant unit. Method: Using the FACT JACIE standards as a basis we developed online test system on sharepoint platform using one question from each of the standards with multiple-choice answers. The questions were based on in house Standard Operating Procedures, and included conditioning regimen selection, CD34 target, management of side effects, palliative care etc. (Table 1) Results: 20 and 20 doctors completed the questionnaire. All participants reported that the test was easy to use and convenient. All questionnaires were completed on time with the possibility of repeating the test for those who had errors. Nurses had 100% correct answers whilst ﬁve physicians needed to repeat the test (25%) because of errors (1 with 4 errors, 3 with 2 errors, and 1 with 1 error). Where errors were observed, speciﬁc training was given to cover areas of concern. With repeated testing of staff after further training, participants all scored 100%at the second attempt. All staff had an annual update. Table 1. Sample questions
apheresis attempt. Apheresis units are often nurse led, utilising clinical judgement and decision making to improve patient outcomes and experience. Consequently, nurses have been at the forefront of Plerixafor use ensuring that it is used appropriately, optimally, and cost -effectively. This is imperative in our economically challenged, evidence-based healthcare systems. Our objective was to explore and initiate best practice, and examine the impact that this new therapy has on patient care. Method: Our centre has used Plerixafor since 2008 when we administered the drug at 12 midnight necessitating a hospital admission. Following licencing, in 2011 we changed our dosing schedule to 5pm. We have reviewed the literature, communicated with other centres, and evaluated our institutional data to assess if this new dosing regimen and time interval is as effective. Additionally, we wanted to explore the following challenges Plerixafor presents in the clinical setting:
– – – – – – –
Timing of Plerixafor administration. The optimal administration time of GCSF pre-apheresis. Optimising procedure efﬁciency. Pre-emptive use of Plerixafor versus re-mobilisation. Commencing apheresis prior to CD34 result. Patient self-administration of Plerixafor. Managing patient expectations of the drug
Conclusion: The online testing system meant that both physicians and nurses could complete the test at a time convenient to them, and the results of the test could be collated and reviewed for to identify any education needs arising. This is an instrument that is easily modiﬁable so that future annual updates/tests can be devised reﬂecting other areas of practice and updates in the clinical area Disclosure of Interest: None Declared. N004 PLERIXAFOR: HOW CAN WE ACHIEVE THE BEST PATIENT OUTCOME? THE ROLE OF THE APHERESIS NURSE J. Baker*,1, E. Kaczmarek1, C. Magsipoc1, C. Panlaqui1 1 Haemato-oncology, Royal Marsden NHS Trust, London, United Kingdom Introduction: Plerixafor (Mobozilt) has enabled many patients to complete an autologous haematopoeitic stem cell procedure following a previous failed mobilisation or
Results: To date there have been no randomised controlled trials comparing dosing schedules. However, several studies have revealed similar outcomes with 15–17 hour dosing versus 11 hour dosing. Our data collected since 2008,involving 43 patients given the drug at 12 midnight, and 87 patients given the drug at 5pm, found no signiﬁcant difference in effectiveness. This dosing schedule, initiated by nurses, was considerably more cost-effective and improved patient satisfaction and experience. We have used Plerixafor pre-emptively to rescue failing mobilisations in 13 patients with 5 pm dosing, with success rates of 80%. We have found one of the greatest challenges is managing high patient expectations of this drug, and eliminating unrealistic perceptions of a ’miracle drug’, as in some patient cohorts failure rates may still be up to 20% in our experience. Conclusion: Plerixafor is an effective drug for stem cell mobilisation. However, it presents challenges for apheresis nurses in order to optimise its use, efﬁciency, and the patient experience, and requires nurses to monitor outcomes and utilise evidence -based practice. 5pm dosing appears to be as
effective as 10pm, and using Plerixafor pre-emptively may be more cost effective and patient- centred. Disclosure of Interest: None Declared.
EBMT / MASCC / ISOO Joint Session N005 BASIC ORAL CARE FOR HEMATOLOGY-ONCOLOGY PATIENTS AND HEMATOPOIETIC STEM CELL TRANSPLANTATION RECIPIENTS: A POSITION PAPER FROM THE JOINT TASK FORCE OF MASCC/ISOO AND EBMT A. Mank*,1, B. Quinn2, E. Wallhult3, J. Raber-Durlacher4,5, S. Elad6,7, M. T. Brennan8, D. P. Saunders9, Y. Zadik10,11, J. B. Epstein12, N. M. Blijlevens13, T. Waltimo14, J. R. Passweg15, M. E. P. Correa16, G. Dahllo¨f17, K. U. Garming-Legert18, R. M. Logan19, C. M. Potting20, M. Y. Shapira21, Y. Soga22, J. Stringer23, M. A. Stokman24, S. Vokurka25, N. Yarom26,27, S. B. Jensen28 1 Academic Medical Centre, Amsterdam, Netherlands, 2Chelsea and Westminster NHS Foundation Trust, London, United Kingdom, 3 Section of Haematology and Coagulation, Department of Internal Medicine, Sahlgrenska University Hospital, Go¨teborg, Sweden, 4Academic Medical Center Amsterdam, Department of Oral and Maxillofacial Surgery, University of Amsterdam, 5Department of Medical Dental Interaction, Academic Centre for Dentistry Amsterdam, Amsterdam, Netherlands, 6Division of Oral Medicine, Eastman Institute for Oral Health, 7Wilmot Cancer Center Strong Memorial Hospital, University of Rochester, Rochester, 8Department of Oral Medicine, Carolinas Medical Center, Charlotte, United States, 9Department of Dental Oncology, Health Sciences North, North East Cancer Center, Sudbury, Canada, 10Department of Oral Medicine, Hebrew University-Hadassah School of Dental Medicine, Jerusalem, 11Israeli Air Force General Surgeon Headquarters, Israel Defense Forces Medical Corps, Tel Hashomer, Israel, 12Division of Otolaryngology and Head and Neck Surgery, City of Hope, Duarte, United States, 13Department of Haematology, Radboud university medical center, Nijmegen, Netherlands, 14Klinik fu¨r Pra¨ventivzahnmedizin und Orale Mikrobiologie, Universita¨tskliniken fu¨r Zahnmedizin der Universita¨t Basel, 15Klinik Ha¨matologie Bereich Innere Medizin Universita¨tsspital Basel, Basel, Switzerland, 16Oral Medicine; Dental Ambulatory of the Hematolgy and Hemotherapy Center, Piracicaba Dental School, University of Campinas, Campinas, Brazil, 17Department of Dental Medicine, Division of Pediatric Dentistry, 18Department of Dental Medicine, Division of Orofacial Diagnostics and Surgery—Oral Medicine and Pathology, Karolinska Institutet, Huddinge, Sweden, 19Oral Diagnostic Sciences, School of Dentistry, The University of Adelaide, Adelaide, Australia, 20Department of Hematology, Radboud University Medical Center, Nijmegen, Netherlands, 21BMT & Cancer Immunotherapy Department, Hadassah-Hebrew University Hospital, Jerusalem, Israel, 22Division of Hospital Dentistry, Central Clinical Department, Okayama University Hospital, Okayama, Japan, 23 The Christie NHS Trust, Manchester, United Kingdom, 24Department of Radiotherapy and Oral & Maxillofacial Surgery, University Medical Center Groningen, University of Groningen, Groningen, Netherlands, 25Department.of Heamatology-Oncology, University Hospital in Pilsen, Plzen (Pilsen), Czech Republic, 26Department of Oral & Maxillofacial Surgery, Sheba Medical Center Tel-Hashomer, Tel-Hashomer, 27Department of Oral Pathology and Oral Medicine, School of Dental Medicine, Tel-Aviv University, Tel-Aviv, Israel, 28Section of Oral Medicine, Clinical Oral Physiology, Oral Pathology & Anatomy, Department of Odontology, Faculty Of Health Sciences, University of Copenhagen, Copenhagen, Denmark Introduction: Hematology-oncology patients undergoing chemotherapy and hematopoietic stem cell transplantation (HSCT) recipients are at risk for oral complications, which may cause signiﬁcant morbidity, and a potential risk of mortality. This emphasizes the importance of basic oral care prior to,
during and following chemotherapy/HSCT. While scientiﬁc evidence is available to support some of the clinical practices used to manage the oral complications, expert opinion is needed to shape the current optimal protocols. Method: This position paper was developed by members of the Oral Care Study Group, Multinational Association of Supportive Care in Cancer/International Society of Oral Oncology (MASCC/ISOO) and the European Society for Blood and Marrow Transplantation (EBMT) in attempt to provide guidance to the health care providers managing these patient populations. Results: The protocol on basic oral care outlined in this position paper is presented based on the following principles: prevention of infections, pain control, maintaining oral function, the interplay with managing oral complications of cancer treatment and improving quality of life. Conclusion: Using these fundamental elements, we developed a protocol to assist the health care provider and present a practical approach for basic oral care. Research is warranted to provide robust scientiﬁc evidence and to enhance this clinical protocol. The paper is published in journal of Supportive Care in Cancer and is the starting point for further collaboration between MASCC/ISOO and the EBMT regarding the topic of Mucositis and Oral Health Care. Disclosure of Interest: None Declared.
Oral Session 2 N006 DEVELOPMENT OF A PATIENT SELF-EVALUATION QUESTIONNAIRE FOR HSCT FOLLOW UP S. Liptrott*,1, G. Andreola2, A. Gardellini2, F. Gigli2, R. Pastano2, D. Laszlo2 1 Division of Haemato-oncology, European Insitute of Oncology, 2 Division of Haemato-oncology, European Institute of Oncology, Milan, Italy Introduction: Haematopoietic stem cell transplantation (HSCT) is a lifesaving procedure for many patients (pts). Important short- and long-term effects of HSCT are noted and pts are monitored for complications during outpatient clinic visits. Visits with the clinical team are limited to 30 minutes per patient, which includes discussion, review of lab tests, imaging, physical examination etc. This short time frame means that communication between clinical team and patient & carers, needs to be focused to provide a holistic assessment, appropriate management and support. It is recognised that pt self reports can aid in management, but this depends on what is reported during the visit, and may be limited by recall and what key probing questions come from the clinical team. Although patient self evaluation tools are available, they are often used retrospectively, and no tool for proactive use in facilitating SCT follow up clinic visits is available. Method: A review of the literature was performed, identifying complications and associated symptoms following HSCT. These included GI disturbances, skin, respiratory, eyes, genito-urinary, mobility, neurological and general problems. They were listed, with a simple ‘yes’, ‘no’ to identify the presence of the symptom, and space for ‘other’ symptoms to be reported. The self-evaluation questionnaire was then given to HSCT experienced medical staff, and to 7 consecutive pts attending the HSCT follow up clinic for review. Verbal and written comments were recorded. Results: Four members of the medical team reviewed the content of the self-evaluation questionnaire and provided feedback. Seven pts were given the questionnaire (2 female, 5 male), mean age 48 yrs (range 29-70). One pt had undergone 2 allogeneic SCT’s and was day þ 2268 and day þ 100. Of the remaining pts, mean time since SCT was þ 362 days (range
100-969). Patients had undergone myeloablative and nonmyeloablative conditioning regimes. Feedback was positive from all pts, and comments included ease of compilation of the self-evaluation tool, utility as a reminder for problems pts wanted to highlight to the doctor at home but often forgot, easier to understand when symptoms are written and the value of being able to talk about what was important for the patient. One pt suggested the addition of ‘advice’ for ‘simple problems’ at home e.g. headache, sore throat, and social life, which would assist in recovery. Conclusion: We have developed a simple & easy to use selfevaluation tool for pts having undergone allogeneic SCT, which allow pts to identify their needs and issues, aiding in ensuring a collaborative approach to care. Pts comments would suggest that they also require ongoing advice and support. We plan to implement this tool, recording pt reported symptoms and congruence with clinical evaluation in order to tailor care appropriately. Disclosure of Interest: None Declared. N007 EARLY DISCHARGE MODEL AND HOME-CARE TREATMENT FOR PATIENTS WITH MULTIPLE MYELOMA RECEIVING HIGH DOSE MELPHALAN AND AUTOLOGOUS STEM CELL TRANSPLANTATI L. Russo*,1, G. Cusumano1, S. Gallo1, G. Campolo1, G. Morabito1, T. Trimarco1, N. Meliambro1 1 Azienda Ospedaliera Bianchi Melacrino Morelli, CTMO, Reggio Calabria, Italy Introduction: Several experiences on the outpatient management of patients with aplastic multiple myeloma (MM) after high dose melphalan (HDM) have been published, and have demonstrated that the outpatient program is feasible and safe. In this way, however, patients experience time-consuming daily travel to the outpatient clinic for blood tests and physician check-up. Home-care (HC) is an alternative, designed to reduce hospital outpatient admissions by providing hospital equivalent care to patients in the home setting. Method: We conducted a preliminary study to demonstrate the feasibility of an early-discharge model (EDM) and HC treatment for patients with MM receiving HDM with autologous stem cell transplantation. Patients who lived within a 20 min drive from hospital were discharged to their private home the day after stem cell infusion. Patients at home had to meet the requirements of: a caregiver who was willing to stay at home and help, and approval of the home by the staff of the bone marrow transplant unit. The staff required that there be no pet animals at home, the sheets be changed once a day and that the home be cleaned once a day and delivered all supportive care at home until hematological recovery. This assistance was a special kind of home hospitalization because it provides all cares typical of an intense therapy in patients’ home by hematologist and transplant specialist nurses with: a) clinical examination performed twice daily (in the morning and in the afternoon), b) daily physician oversight of all evaluations; c) daily registered- nurse evaluations, d) blood sampling for laboratory investigations and cultures; d) transfusion of blood products; e) infusion of parenteral antibiotics; f) monitoring of checklists completed by patients and relatives; g) recording of temperature and drug and ﬂuid intake; h) and dealing with any complaints. Healthcare professionals provided the supply of medications, and performed pulse oximetry for monitoring the patient’s O2 saturation as well as electrocardiography, in the home. Results: Eight patients received 15 transplants. Febrile neutropenia (FN) incidence was observed in 6 procedures for a median 1 day. Biologically documented infections were recorded in one case with A-N1H1 virus infection. During the aplastic phase readmissions occurred in two of 15 (13%) HC courses; all readmissions were caused by fever. Conclusion: No transplant-related death was observed. In conclusion, HC following an EDM in patients with MM could be
a novel approach, and more robust prospective studies are now required. Disclosure of Interest: None Declared. N008 OUTPATIENT ALLO, A CONTINUING STORY ABOUT IMPROVING THE QUALITY OF CARE A. Kramers*,1, I. Kampman1, A. Overbeek-Kok1, A. Nijntjes1, O. Visser1 1 Hematology, VU UNIVERSITY MEDICAL CENTER, Amsterdam, Netherlands Introduction: In 2011 we introduced reduced intensity allogenic stemcelltransplantation in a complete outpatient setting. The conditioning we use is total body irradiation (FLU/ TBI) 2 Gy with ﬂudarabine orally. Method: Every year, we evaluate the whole procedure with all members of the transplantant team ((doctors, nurses, transplantation coordinators, clinical nurse specialist, a.o.) by analyzing data and check our quality system. We also evaluate every procedure with the patient and their spous/ caregiver. Results: We offer the outpatient allogenic stemcelltransplantation to a selected group of patients: – Patients with AML, ALL, MDS, MM and NHL with an indication for allo-RIST and FLU-TBO conditioning regimen – oAge of 70 - Eligible to inclusion criteria (travelling time o1 hour, spous/ caregiver 24 hour availability, medication adherence, etc.) The procedure is now in use for almost four years and several adjustments have been made. Some issues occur to be solved. For example: – It appears that 54.5% of the patients have a cyclosporine at a low level (o250 ug/L) at day-1. We now sort out if adjustments of the instructions or prescriptions need to be made. – From evaluations with patients and their spouses, it appears that some spouses need more attention throughout the procedure – Some patients feel unsecure during the days 0 and day þ 5 (ﬁrst check-up after TX). During this period there is no standard contact with the hospital. We now offer patients to have contact by telephone at day þ 2 with the nurse of the outpatient ward. Conclusion: The procedure of outpatient allogenic hematopoietic stemcelltransplantation is standard care for selected patients in our department. After 3 years, we are able to adjust protocols and ﬁne-tune individual patient for logistic reasons. Disclosure of Interest: None Declared. N009 BARRIERS AND FACILITATORS FOR NURSES AND PHYSICIANS DISCUSSING SEXUAL ISSUES WITH PATIENTS FOLLOWING HEMATOPOIETIC STEM CELL TRANSPLANTATION C. Eeltink*,1, J. Stringer2, E. Johansson3 and Complications and Quality of Life 1 Hematology, VU UNIVERSITY MEDICAL CENTER, Amsterdam, Netherlands, 2Hematology, Christie, Manchester, United Kingdom, 3Hematology, Karolinska University Hospital, Stockholm, Sweden Introduction: Studies have demonstrated that there is an increasing awareness of the impact HSCT has on patients’ sexuality. Regardless of such data, there is concern that sexuality is an issue which may not be addressed in a standardised manner by clinicians during post-HSCT follow up. The aim of this study was to explore possible barriers and facilitators to monitoring of sexual function post HSCT. Method: A self-administered questionnaire devised by Moore et al. (2013) was adapted for use with HSCT staff. The questionnaire consisted of 4 sections: demographics and
education, perceived barriers to discussing sexuality, potential facilitators for discussing sexuality, and comments. It was available in French, German, Dutch, Italian and English. The questionnaire was sent as an online survey to all principal investigators and their principal nurse of the 193 center of the European Society for Blood and Marrow Transplantation (EBMT). Results: 436 members responded with 323 members completing all questions. Lectures on sexual health were included in preregistration education of 71% registered nurses (RN) and 59% medical doctors (MD). Those who received such education however, did not discuss sexual issues with patients signiﬁcantly more than those who had not. A major barrier for RNs and MDs discussing sexuality (28% and 36% respectively), was a lack of services to refer the patients to. This was followed by; lack of privacy for RNs (27%); heavy workload and lack of time for MDs (31%). Regarding patient speciﬁc barriers the most important ones concerned having discussions with patients who are of a different religion, or who have a mental health problem. Overall, RNs reported feeling less comfortable than MDs talking to patients about HSCT impact on sexual function and fertility. There was a positive correlation between the level of academic qualiﬁcation and comfort levels. Being asked questions by the patient about their sexuality was identiﬁed as the best facilitator, for RNs (98%) and MDs (94%) Having knowledge of the perceived sexual difﬁculties was second best for RNs (89%) and having sufﬁcient time to sit and talk to the patients for MDs (85%). Conclusion: As more patients survive HSCT long term, it becomes imperative that RNs and MDs standardize their approach to discussions about issues such as sexual health with their patients and make use of the factors that facilitate discussions. Disclosure of Interest: None Declared. N010 IS THERE A NEED TO ESTABLISH SPECIALTY WOMEN’S HEALTH CLINIC FOR SURVIVORS OF HAEMATOPOETIC STEM CELL TRANSPLANT (HSCT)? MODEL FOR IMPROVING AND EXPANDING THE SURVIVORSHIP PROGRAMME A. Leather*,1, J. Stringer1, S. Kulkarni1 1 The Christie, Manchester, United Kingdom Introduction: Sexual functioning is a signiﬁcant factor in survivorship post HSCT. There are increasing reports in the literature of; patient embarrassment about discussing these issues, difﬁculty identifying concerns by health care professionals. To evaluate the incidence of developing GVHD, case notes of patients who had received an allograft since 2010 were reviewed. A total of 188 patients (67 female /121 male) were studied. Acute GVHD developed in 47.9% and chronic GVHD developed in 87%. Further analysis highlighted that there was scanty information available about the involvement of perineum and genital tract. It was felt that the incidence of perineal/genital GVHD was underestimated because the information was not volunteered by the patients or reluctance on the part of health professionals to ask the questions of sensitive nature. Lack of advice and subsequent treatments of any sexual dysfunction can have a negative impact on the patient quality of life. A women’s health clinic was therefore established to offer education, support, and treatment to women who had received a donor HSCT. Method: A clinic template was developed to give structure to the consultation. This was used as a platform for education and a springboard for patients to ask questions. A ﬂow chart for standardisation of intervention was also developed, along with a patient information pack. The clinic runs ones a week and offers 30 minutes slots per patient. As this service was new and personal in nature participants were requested to evaluate its utility by using questionnaires regarding appropriateness of
the consultation with the aim to assess the utility and ways to improve delivery of service. Results: The clinic commenced August 2014. Early assessment revealed that in the ﬁrst 6 weeks, 19 patients were invited, an attendance of 84% was achieved. The results of the questionnaire revealed that all the women found clinic very helpful and often agreed that they had problems they did not discuss during appointments with transplant clinicians. 50% of these patients had issues pre clinic and 25% were unsure. Majority of patients (83%) reported having no symptoms pre transplant; the same number had some symptoms post HSCT. All patients agreed that they were relieved to have been able to speak with someone and many commented on the beneﬁt of having a female to talk to. 50% of patients felt they were alone with the problem and 50% of partners had already expressed concern. Conclusion: The results have been overwhelming positive and validated the need for continuation. The Majority of woman reported suffering some sexual dysfunction. The clinic highlighted the beneﬁt of a ‘user friendly’ forum for women to talk, many felt uncomfortable speaking with male consultants and often felt the ‘this was just another thing’. Disclosure of Interest: None Declared.
Oral Session 3 N011 TOTAL OUTPATIENT AUTOLOGOUS HAEMATOPOIETIC STEM CELL TRANSPLANTATION USING AMBULATORY CARE: DELAYED ADMISSION MODEL—THE SHEFFIELD EXPERIENCE A. Gibbard*,1, A. Nield1, J. Wright1, J. Snowden1, N. Morley1, C. Dalley2, S. Simpson1, S. Ward1 1 Shefﬁeld Teaching Hospitals NHS Foundation Trust, Shefﬁeld, 2 Brighton and Sussex University Hospitals, Brighton, United Kingdom Introduction: With an ever increasing demand for transplant procedures, rising bed pressures and the constant drive for economic efﬁciency within the NHS; the Trust needed to develop more effective systems to meet the needs of its catchment population. We developed novel treatment pathways to allow patients to undergo daily assessment and treatments for autograft in a day-case unit setting using ambulatory care (AC). Patients are reviewed by a nurse practitioner with the support of a haematologist and receive the same level of care as those having in-patient autografts. All patients are closely monitored for signs of treatment related toxicity and infection using a simple proforma which forms the basis of the consultation. As well as daily blood tests, patients receive a physical examination. Close links are maintained with the palliative care team and dieticians. The patient remains in AC until either their condition requires escalation to in-patient care, or upon patient/carer request. Method: Our primary aim was to improve the service without compromising patient safety. We set the following objectives: determine the feasibility of using AC to improve the patient experience; relieve bed pressures allowing a greater ﬂexibility within the service; prove cost-effective; record incidents and collect patient feedback. Results: Between 2011 and September 2014, 59 autografts were performed using AC: 33 for multiple myeloma, 23 for lymphomas and 3 for teratoma. Myeloma patients spent an average of 59% of their total care episode in AC; 8 patients spent 100% of the care episode as an outpatient. Lymphoma patients spent an average of 54% of their care episode in AC, with 1 patient having 100% outpatient management. A total of 653 bed nights were saved. Patient feedback was positive, 89% rating their overall experience as 4/4 (very satisﬁed) and 11% rating their experience as 3/4 (satisﬁed). Comments
from the surveys included: ‘Not conﬁned to hospitaly yﬂexibility to eat elsewherey ymore privacy and freedom of movement.’ No patient safety issues were encountered. Conclusion: AC offers a viable solution to the pressures faced by modern health services. We demonstrated a signiﬁcant reduction in bed nights, whilst providing patients with a greater freedom of choice. All of this was achieved without compromising patient safety. Disclosure of Interest: None Declared. N012 EXPLORING THE LIVED EXPERIENCE OF NURSES CARING FOR ALLOGENEIC STEM CELL TRANSPLANT PATIENTS J. Baker*,1, S. Stapleton2, M. Coughlan3, T. Wiseman2 1 Haemato-oncology, 2Research Dept, Royal Marsden NHS Trust, 3 The Royal Marsden School, Sutton, Surrey, United Kingdom Introduction: Allogeneic Stem Cell Transplant (ASCT) is increasng as a treatment modality for haematological malignancies. Despite technological advances there remains signiﬁcant morbidity and mortality. Twenty- ﬁrst century healthcare, with its inherent economic and political implications, exempliﬁes nurses as a fundamental resource, and the need to retain skilled nurses is essential to sustain technologically advanced therapeutic interventions to improve cancer survival outcomes. As a result of accreditation and regulation, ASCT units are subjected to numerous quantitative evaluations and measurements, yet there has been little exploration of the qualitative experience of ASCT nursing from the persepective of the nurses at the bedside. Much of the existing literature has focused on end of life issues and occupational stress, but there is a paucity of research exploring the totality of ASCT nurses’ experience of caring for these patients. Method: The aim was to gain insight into the world of ASCT nursing by developing an understanding of how nurses care for this patient population, to elicit their perceptions of ASCT, to ascertain how nurses ﬁnd fullﬁllment in this work, and to explore the challenges. A qualitative phenomenological framework was applied, and 8 ASCT nurses (caring for adult and teenage patients) completed unstructured audio-taped interviews. These were transcribed and essential themes were extrapolated from the text, and meanings interpreted. Results: The themes that emerged reﬂected the daunting dichotomy of ASCT nursing, incorporating the uncertainty and the intensity. Essential concepts speciﬁc to the phenomenon of ASCT nursing that resonated with the participants were related to the perceived uniqueness, complexity, intensity, and grief experienced when caring for this patient population. However, they also reﬂect the hope, thrill, and opportunities it presents, and fundamentally the signiﬁcant input that their skilled nursing can contribute. The following themes were identiﬁed: the wonder of it; caring during uncertainty; sharing in the journey of rebirth; being a slave to routine and the medical model; the paradox of cure; and connection and disconnection. Conclusion: ASCT nursing is complex and multidimensional. It can place an extraordinary burden on nurses, but can also be a source of signiﬁcant eustress (or ’good stress’). By gaining a deeper understanding of ASCT nursing, it may be possible to develop mechanisms and interventions to nourish and retain these nurses, ultimately sustaining exemplary patient care in this speciality.Findings indicate that some stressors in ASCT nursing result from the culture of care in these units, and the prominence of advanced nursing practice may be instrumental in inﬂuencing this culture through expert leadership, education, support,credibility, and evidence-based practice. Disclosure of Interest: None Declared.
N013 BLENDED LEARNING ENHANCES THE CAPACITY OF NURSES IN THE FIRST BONE MARROW TRANSPLANT UNIT IN COLOMBO, SRI LANKA S. Siddique*,1, C. Zuanelli2, L. Faulkner3 1 International Nursing Coordinator, CURE2CHILDREN FOUNDATION, London, United Kingdom, 2Trainee BMT physician, 3 Medical Coordinator, CURE2CHILDREN FOUNDATION, Florence, Italy Introduction: Cure2Children foundation (C2C) collaborated with the Asiri Central Hospital (ACH) in Colombo, Sri Lanka to set up country’s ﬁrst Bone Marrow Transplant (BMT) unit in June, 2014. Among many other challenges, one of the major challenges was to train nurses in a start up BMT unit to understand and competently provide care to BMT patients. Nursing education is generally inadequate in low and middle income countries. But as evidenced by several recent studies, the successful treatment of children with cancer highly depends on the provision of specialised nursing care that requires advanced knowledge and clinical skills. Keeping this in mind, C2C implemented blended learning education model to train local nurses in the new BMT unit at ACH. Blended learning is a combination of different interactive teaching methods which include internet-based learning coupled with traditional face-to-face lectures. The aim of this experience is to highlight the advantages of blended learning in maximising the ability of new nurses to improve their self conﬁdence and advanced knowledge in a new clinical speciality such as BMT. Method: Six nurses were assigned to work in the BMT unit at ACH. All six nurses participated in the education program in a blended learning environment. This comprised of 2 weeks of interactive face-to-face lectures, e-learning activities, and 6 weeks of clinical supervision by BMT specialist nurse and physician. Education topics were BMT speciﬁc such as central line management, chemotherapy administration, infection prevention and control, family education, quality management and data management. Results: At the end of the education program the evaluation data was collected from the assessment test results after the course which consisted of scenarios and multiple choice questions (N ¼ 75) relevant to BMT nursing care prepared by BMT nursing and medical coordinator. All 6 nurses completed the assessment in C2C database (BMT plus). On average nurses score was 66% with the highest score 80% and lowest 51%. Nurses reported that the knowledge gained through the course was fully transferable to their daily practice and boosted their conﬁdence in clinical decision making. The BMT unit at ACH has so far performed 4 allogeneic matched related transplants for thalassemia major with a 100% success rate. Conclusion: This experience demonstrates that blended learning positively impact the orientation of new nurses and offers a cost effective alternative to residential learning methods in which nurses from developing country travel to developed country which is rarely feasible. This approach also makes training more ﬂexible with potential to be delivered in a variety of settings without extensive disruption to work schedule. Moreover, this experience may help organisation focusing on international outreach in deciding and planning future education for nurses in start up centres. Disclosure of Interest: None Declared.
N014 PARENTAL EXPERIENCES AND PERSPECTIVES OF END-OF-LIFE DECISION-MAKING IN ALLOGENEIC PAEDIATRIC STEM CELL TRANSPLANT H. Mekelenkamp*,1, A. Lankester1, M. Bierings2, L. Ball1, M. Kars3 1 Pediatric stem cell ward, Leiden University Medical Centre, Leiden, 2Pediatric stem cell ward, 3Department of Medical Humanities, Utrecht Medical Centre, Utrecht, Netherlands Introduction: Despite the curative potential of SCT not all children survive. Little is known about parental end-of-life (EOL) decision-making. A better understanding of the parents’ experiences and perspectives about EOL decision-making in paediatric SCT can help healthcare professionals to support parents in decision-making and to improve (after) care. This study explored parent’s experiences and perceptions of EOL decision-making after allogeneic paediatric SCT. Method: A retrospective, qualitative Grounded Theory study was performed. Face to face, in-depth open interviews with twelve parents individually of seven children who died within a year after SCT were conducted and qualitatively analysed. Interviews were coded and categorized; resulting in a thematic description. Results: Three themes were identiﬁed. 1) ‘Dealing with decision-making’. Parents followed the professionals’ suggestions for treatment options based on trust and hope for recovery. Most parents emphasized they lacked a frame of reference to decide on treatment options themselves. The child’s suffering was one of their hardest feelings, the parents’ hope for cure helped them to cope with it. In addition parents maximized treatment options to prevent themselves from regret afterwards. 2) ‘Making the most of opportunities’ refers to using all treatment possibilities offered by the specialized medical team, but simultaneously being critically involved with the decision-making process. 3) ‘Being a good parent’. This meant for parents considering and following their child’s wishes in making decisions as well as supporting the child and the family members. This role also helped parents to support themselves throughout the SCT and demonstrated their commitment to their child (not to give up). In hindsight most parents felt doubts about having missed chances or about the meaninglessness of the child’s suffering during the terminal stage. All parents experienced feelings of intense loss; the EOL period was in most cases experienced as an emotional rollercoaster characterized by complications and suffering. Conclusion: In hindsight parents did not feel they had made decisions themselves during SCT, rather they tended to follow all possible treatment options offered by the healthcare professionals. During EOL some parents agreed to stop further treatment, principally to relieve the child’s suffering. Many parents struggled with gaining a frame of reference that enabled them to make EOL decisions.The outcomes of this study suggest that the SCT team should consider when and in what way they inform parents and children about a possible upcoming death during SCT, as well as means to improve individualised shared decision-making. Ethnographic, prospective research with healthcare professionals, parents and perhaps patients is suggested to gain further insight. Disclosure of Interest: None Declared. N015 SEXUALITY AND SEXUAL FUNCTION ONE YEAR AFTER ALLOGENEIC HEMATOPOIETIC STEM CELL TRANSPLANTATION K. Nørskov*,1, I. Schjødt1, M. Jarden2 1 Hematology, 2University Hospitals Center for Health Research (UCSF), UNIVERSITY HOSPITAL OF COPENHAGEN, Copenhagen Ø, Denmark Introduction: Allogeneic hematopoietic stem cell transplantation (HSCT) involves severe immune-related complications, in particular Graft versus Host Disease (GVHD), which is
the primary cause of morbidity, mortality and decreased quality of life after HSCT including sexual dysfunction. Aim: To examine the association between treatment with HSCT and sexual dysfunction one year after HSCT including the association between chronic GVHD and sexual dysfunction one year after HSCT. Method: The study is a controlled, prospective cohort study with baseline assessment 2-3 weeks prior to HSCT and follow-up one year after HSCT. All patients (Baseline: n ¼ 124, Follow-up: n ¼ 63) were recruited from the Department of Haematology, Copenhagen University Hospital, in the period from October 2010 to November 2013. Patients completed the ‘‘SFQ: Sexual Functioning Questionnaire’’ and descriptive data were obtained at both time-points Results: Both genders declined in sexual function, and the prevalence of physical sexual problems increased or remained consistent. At follow-up, 47% men and 60% women reported at least one physical sexual problem. Patients with chronic GVHD reported higher level of sexual dysfunction. Women reported a high prevalence of symptoms on genital GVHD and in addition women with chronic GVHD scored signiﬁcantly worse on sexual function problem subscale. Conclusion: Sexual dysfunction is a late effect that does not recover one year after treatment, and both genders experienced increased sexual dysfunction one year after treatment. Disclosure of Interest: None Declared.
Oral Session 4 N016 JOINT PSYCHO-ONCOLGIST AND CLINICAL NURSE SPECIALIST TRAINING—A PILOT PROJECT USING A CASE BASED TEACHING APPROACH TO SUPPORT HAEMATOLOGY NURSES IN ADDRESSING PSYCHO-SOCIAL ASPECTS OF CARE J. Horn*,1, K. Jardine2 1 Haematology, 2Psycho-oncology Department, Aberdeen Royal Inﬁrmary, Aberdeen, United Kingdom Introduction: Addressing the psycho-social needs of the patient is integral in providing holistic cancer care, however cancer nurses often fear situations where the patient expresses emotions that they may be unable to manage. Psychological skills training has been shown to improve care, reduce staff burn-out and aid staff retention in the cancer care setting. A pilot project was undertaken, offering teaching sessions jointly lead by a psycho-oncologist and haematology clinical nurse specialist (CNS). The aim was to combine clinical education with discussion of the psycho-social aspects of care using a case-study approach. The target audience was outpatient therapy nurses, clinical trials nurses and student nurses based in the haematology and transplant unit of Aberdeen Royal Inﬁrmary. Method: Out-patient therapy nurses, clinical trial nurses and student nurses were invited to participate in informal teaching sessions lead jointly by the psycho-oncologist and haematology CNS. Each session focused on one identiﬁed patient who had presented challenges to the team. The sessions included a clinical introduction by the CNS and discussion of the disease process, treatment and outcomes. This was follwed by analysis and discussion of relevant psycho-social issues, lead by the psycho-oncologist. Nurses were asked to complete pre and post teaching questionnaires for evaluation. Results: Sessions have been well attended relative to the size of the unit and staff have actively participated in the
discussion element. A number of themes have been discusses in depth, including:
– – – –
Denial. Control. Uncertainty. Loss and adjustment
Teaching sessions are ongoing but interim evaluation has indicated that staff feel more conﬁdent in recognising, discussing and assessing the psycho-social needs of their patients. Qualitative feedback suggests that nurses also appreciate the opportunity to gain a more rounded understanding of their patients whole life experiences. They also strongly value the opportunity to hear and share the views and opinions of their colleagues in a safe and supportive environment. Conclusion: Early indications are that this is a useful approach to supporting nurses in their daily work with complex patients. They have indicated interest in continuing this project as an ongoing part of their continuing professional development. Following full evaluation we plan to expand this project to include the in-patient ward facility, which has unique challenges. We envisage that this teaching model may be transferable to the wider cancer care setting. Disclosure of Interest: None Declared. N017 A 100% LIFE AFTER TRANSPLANT: EDUCATION PROGRAM OF PATIENT SUPPORT C. Veronique*,1, H. Soraya1, T. L. Murielle1, L. Laurence2 1 Me´decine, 2Spe´cialite´ de me´decine, Hoˆpital cantonal universitaire Gene`ve, Geneva, Switzerland Introduction: The bone marrow transplant is a complex treatment which is growing. The number of transplants has increased in Geneva in recent years (38 transplants in 2009 to 71 in 2014) and we need to develop an education patient program to face in safety to this situation. We have deﬁned the patient journey by building an education program regarding each different phases of the graft: clinical assessment, transplantation and discharge from the hospital. Method: We base our program on the Meleis theory of transition related to the therapeutic education concepts. It focuses on each period crossed by the patient through the transplant care route. The objectives of this program are: ensure continuity of care and prepare the patient to cross each stage, develop skills to manage the patient care by promoting autonomy, create motivation in the context of vulnerability, reduce the risk of serious graft complications (Gvhd, infection), optimize the quality of hospitalized stay. The implementation of this program is structured in two parts: developing a patient education program based on the needs identiﬁed in each phase of care, train health care to the principles of therapeutic education and motivational interviewing for every patient and create information tools. The approach is built around a patient pathway. Conclusion: This program by exploring the transition process associated with the different stage of the disease promotes the full patient participation in education. It also permits to discharge earlier patient from hospital and also empowers patient autonomy in health behavior. In the future, this program will be used for educate any patient hospitalized with hematological disease and for developing ambulatory transplants. Disclosure of Interest: None Declared.
N018 CARING FOR FAMILY-RELATED-DONORS: A MULTIDISCIPLINARY APPROACH A. Polomeni*,1, C. Hennebelle2, A. -S. Le Bihan3, A. Mjid4, C. Ratie´5, M. T. Rubio6, A. L. Ruggieri4, R. Belhocine3, M. Mohty5 1 Service d’He´matologie clinique et the´rapie cellulaire, Hopital Saint antoine Assistance Publique Hoˆpitaux de Paris, 2service d’he´matologie, hoˆpital saint antoine, 3service d’he´matologie, 4 service d’he´amtologie clinique, 5service d’he´matologie clinique, 6 service d’he´matlogie clinique, hopital saint antoine, paris, France Introduction: In the allogeneic stem cell transplant setting (HSCT), HSCT-Coordinating Nurses (CN) play a major role in delivering information to potential donors, organizing HLA tests, pre-donation work-up, and stem cell collection as well as providing support through the donation process. This multifaceted experience allowed CN to perceive the complexity of related-donation and its speciﬁc ethical and psychological issues. In order to cope with difﬁcult situations such as conﬂicting family relationships, donation refusal or withdrawal, as well as donors’ ambivalent feelings and psychological distress, our CNs propose a systematic psychological interview during the pre-donation work-up day Method: Such psychological interview aims to identify and address related-donors’ psychological difﬁculties and support their needs prior, during and post-HSCT. It takes place after the medical consultation and after the individual information session performed by the CN. Such psychological interview offers to related-donors a setting in which they can ask questions that they could not ask before, to reword their own understanding of medical information, to express their feelings regarding their close relatives’ disease and their expectations (and doubts) regarding HSCT. Also, this interview can also be an opportunity to talk about family conﬂicts, relationships difﬁculties and donation impact on family dynamics. Moreover, this ﬁrst contact with HSCT-Unit’s psychologists may foster related-donors to ask for assistance later in HSCT course. Results: From January 2012 to September 2014, 95 adult related-donors were identiﬁed in an single centre HSCT program. The psychological interview was proposed to all of them; but 44 interviews were actually performed. Our ﬁndings suggest that related-donors have to handle a delicate balance between their personal concerns (e.g. socio-professional constraints, ﬁnancial difﬁculties, fears of the procedure and its potential consequences) and the vital risk which threatens his (her) family member. This dual challenge inﬂuences both donation’s decision and experience. Related-donors frequently fear harvesting procedure and a negative impact of donation on their own health. They also suffer from emotional stress linked to receiver’s condition and HSCT outcomes. A main issue is the fact that these donors can not easily talk about their feelings regarding HSCT and donation with their close relatives, which core preoccupations are turned to recipient. Conclusion: With the aim to minimize potential harm for related-donors, we conclude that the pre-donation psychological interview provided related-donors an appropriate frame to tackle their own concerns regarding donation. The latter may allow to prevent later emotional difﬁculties, especially in case of recipients’ severe complications such as GVDH, relapse or death. Disclosure of Interest: None Declared.
N019 BACK TO WORK AFTER ALLOGENEIC TRANSPLANT: EXPLORING EMPLOYMENT RATES IN THE LONG-TERM FOLLOW-UP CLINIC M. Kenyon*,1, J. Clay1, C. Wykes2, A. Pagliuca1, G. Mufti1, K. Raj1 1 Haematological Medicine, King’s College Hospital NHS Foundation Trust, London, 2Department of Haematology, Maidstone and Tunbridge Wells NHS Trust, Maidstone, United Kingdom Introduction: Finance and employment are leading concerns post-HSCT. The economic cost of cancer is a substantial personal and societal problem. An annual d5.3 billion commercial shortfall is caused by survivors not returning to work; 92% lose income, adversely impacting QoL for 40%. Work is extremely important to survivors and has health beneﬁts. Method: We analysed 6 months records from the newly established post Allogeneic HSCT late-effects clinic. Records comprised proformas and Holistic Needs Assessments (HNA)— a self-report tool to identify distress level (0 ¼ none, 10 ¼ maximum) and physical and psychosocial concerns. Data were assessed and statistical tests applied where appropriate to determine signiﬁcance. Results: Patient proformas were assessed (n ¼ 160); 77 m, 83 f, mean age 53 years (19-75) and time post-HSCT 6.6 years (1– 19). A predominance of myeloid and bone marrow failure diagnoses (AML 35%, MDS 26%, AA 13% and CML 9% ) reﬂect King’s HSCT caseload. Most received reduced intensity conditioning (88%) and donor source unrelated (57%) followed by matched sibling (38%) and 5% haplo-identical or cord. Chronic GvHD is present in 26 patients with extensive disease in 4. Ninety-six patients are working; 71 full-time and 25 part-time. Typically, those employed are paid (n ¼ 85) with a few undertaking voluntary work (n ¼ 6) or full-time education (n ¼ 5). Table 1 demonstrates employment rates by age. Karnofsky scores range from 70 to 100 with good to excellent performance status (90-100) in the vast majority (90%). The 4 patients whose Karnofsky is 70 have extensive cGvHD and are not employed. Mean distress score is 2.2 (range 0-10) and commonest concerns are fatigue (13%), weight (8%) and sexual function/ relationships (6%). Distress level and number of concerns are similarly expressed in working and non-working patients. Relationship between Karnofsy and employment status was assessed using Chi2-test and a highly signiﬁcant relationship was found between high performance score and employment (Po0.001).
Employment by age
Age range (yrs) 16-24 25-34 35-44 45-54 55-64 65 þ
Number (patients) 3 13 28 33 47 36
Working 3 11 24 23 26 10
(100%) (85%) (86%) (70%) (55%) (25%)
Not working 0 2 4 10 21 26
(0%) (15%) (14%) (30%) (45%) (75%)
Conclusion: These data demonstrate most patients from this clinic population return to work after transplant, but the proportion of those working declines with increasing age and more notably from age 44. Overall, excepting those with extensive cGvHD, these patients have good performance status, report relatively low levels of distress and few concerns making them an appropriate group to target return to work interventions. Interventions that address return to work issues successfully are likely to beneﬁt the individual and society. Employed
individuals are less costly for the state to support and are likely to consume less health and social care than their non-working counterparts. Disclosure of Interest: None Declared. N020 THE HOPE AND SYMPTOM BURDEN RELATIONSHIP FOR HEMATOPOIETIC STEM CELL TRANSPLANTATION PATIENTS S. Levy1, E. Grayeb*,1, G. Sapir2, M. Ben-Izhak1, A. Nayditz1, R. Zelker2, R. Radiano2 1 Bone Marrow Transplant, 2Nursing Directorship, Hadassah Medical Organization, Jerusalem, Israel Introduction: Hematopoietic Stem Cell Transplantation (HSCT) is a radical process accompanied by high morbidity and mortality, and often the last hope of survival for hematology patients. Patients report multiple physical, cognitive and affective symptoms during the HSCT process. Patients and families have to ﬁnd strength to cope with symptoms and manage stress related to the success of the process. Hope is the belief that a current situation can be changed for the better. Hope empowers, encourages, renews and can be a source of positive energy that serves as an effective strategy and plays a key role in coping with disease and its treatment. There are many studies examining the HSCT patient’s symptoms’ experience and much literature about hope. However, the relationship between them has never been examined. We decided to describe levels of patients’ hope during the transplant process and the connection between hope and symptom burden. Method: A descriptive, prospective longitudinal study sampled HSCT patients at the Bone Marrow Transplantation Unit, at Hadassah Hospital. Data was collected at three time points: upon admission (t-1); two weeks after HSCT (t-2) and three months post discharge (t-3). Each participant completed: M.D. Anderson Symptom Inventory to assess symptom severity and interference; Hearth Hope Index measuring sense of hope; Karnofsky performance status scale and at t-1 demographic and disease questionnaire. Results: 100 patients were recruited to the study from March 2012 until February 2014 with 20 missing due to severe sickness or death. Preliminary results show that a consistently high hope level was reported at all-time points (43.23–43.50/48). However, we observed a variance of symptom burden: at t-1 an average symptom severity level of 1.58/10; at t-2: 4.27/10 and at t-3: 1.94/10. A negative correlation was found between the symptom severity and levels of hope at all three time points, especially prominent, the symptoms of sadness at t-1 (r ¼ -.33), distress (r ¼ -.30) and memory recall (r ¼ -.30). Other early results indicate that Muslims expressed less hope (33.64) at time point t-3 than Jews (41.24) (Po.05). Patients diagnosed with Leukemia experienced signiﬁcantly less hope at t-3 (Po.05). Conclusion: In our study we found an inverse relationship between cognitive, affective symptoms and levels of hope. This relationship is less evident with physical symptoms. We expected physical symptoms to exhibit higher levels of severity together with lower levels of hope. However, the outcomes were inverse to our expectations. It is possible to learn that cognitive, affective symptoms are more likely to inﬂuence patients’ hope levels. Hope can be an emotional source of personal power, a mental or spiritual strategy for hematology (and other cancer) patients to overcome life-threatening diseases. We have just begun to understand the implications and power of hope in this study. Disclosure of Interest: None Declared.
Oral Session 5 N021 AN OVERVIEW OF THE FRENCH NURSES GROUP (FNG) DEVELOPMENT: PRESENT AND FUTURE O. Samsonova*,1 and Caroline Bompoint, Anne Wallart, Myriam Giraud, Sophie Porcheron, Mauricette Michallet, Ibrahim YakoubAgha 1 Lyon Sud Hospital, MBJ, Pierre-Be´nite, France Introduction: The ofﬁcial creation of the FNG took place at the 27th Congress of the EBMT in Paris in 2011. From the need to provide an opportunity for all hematological nurses to have a national representation in the EBMT and disseminate our practices, the existence of the national group allows us to improve the care for patients receiving hematopoietic stem cells transplants (HSCT) and support for their families, exchange of educational materials, organize the educational days for nurses and other caregivers. Method: The focus of this study is to analyze FNG activity, to describe our progress and difﬁculties and to establish the future direction of our development. Actions: Integration of French Bone Marrow Group of Nurses and Coordinators (GFIC-GM) created in 2011 into FNG in order to create a single paramedical BMT entity in France Establishing of the mailing list of GFIC-GM members, research of the means to create our own website The choice of the relevant nurses themes of EBMT Annual Congress by the board team of GFIC-GM, their presentation in cooperation with the physicians during the after-EBMT Annual Meetings in France Participation of GFIC-GM with BMT caregivers in the choice of themes for the Annual National Harmonization Workshops in Hematology since 2012, then elaboration of the common protocols and their publication in French BMT newspapers. Results: The main goals achieved by GFIC-GM after 3 years of collaboration are:
– At the meeting of French Society during Bone Marrow Transplantation and Cell Therapy (SFGM-TC) in October 2012, it was decided to integrate the GFIC -GM into the FNG as College Coordinators. – Since 2013 a half-day educational sessions of BMT nurses is held each year in cooperation with the medical annual congress of SFGM-TC. In 2015 its duration will increase
up to a whole day and the accommodation of the greater number of participants is programmed. – 1st National Day of BMT Coordinators in December 2012 with the Biomedicine Agency. – GFIC-GM website creation in 2014. – Election of a transplant coordinator nurse on the Board of Directors of the SFGM-TC. Conclusion: Currently, the GFIC-GM activity does not stop to develop in terms of quantity and quality. The economic crisis of the last years together with the important workload of the members of the board of FNG make our activity more complicated but it doesn’t affect our motivation to move forward. For a future, we have to progress the advancement of nursing research projects in ﬁeld of BMT care and we need to make sustainable sponsorship for events in which we participate: Workshops, SFGM-TC, Nurses Educational Day, GFIC-GM meetings, EBMT. The survey highlights the importance of close professional collaborating with all BMT caregivers in order to provide clear beneﬁts for all participants (physicians, other EBMT national groups, clinical nurses, SCT-coordinator nurses, statisticians, clinical research technicians, patients associations etc.). Disclosure of Interest: None Declared. N022 NUTRITION TEAM INTERVENTION IN ALLOGENIC HEMATOPOIETIC STEM CELL TRANSPLANTATION UNIT: IMPROVMENT OF PATIENT NUTRITIONAL STATUS S. Lamure*,1, M. Meunier2, V. Attalin2, F. Nathalie1, L. Platon1, D. Kelly1 1 He´matologie Clinique, CHU St Eloi, Montpellier, 2Unite´ transversale de nutrition, CHU Lapeyronie, Montpellier, Montpellier, France Introduction: Nutrition support is requested for allogeneic stem cell transplantation (alloCST). In the clinical hematology departement of Montpellier university hospital a desire to improve this supportive care based on the available data from the relevant literature, has led the interdisciplinary nutrition team (INT) to guide the teams in their practice. This study aims to show the impact of this intervention on nutritional status of the patients. Method: The INT intervened the unit on 2 periods: the ﬁrst was an observation of two month to identify the weak points
in the nutritional support, with the patient assessed on the basis of local practice, and the second one (4 month) where they guided the hematology physicians, nurses and care givers with regard to the energy needs, calorie intake, nutritional prescription and naso-gastric tube placement and maintenance. The comparison of nutrition support, nutritional assessment and energetic debt between 2 groups has been done. Results: This study included 76 patients, average age was 51,5, 53% where male. 29 patients were included in the observation group and 47 in the intervention one. Nutritional status in the 2 groups was comparable: 74% of patient at risk of undernourishment in the observation group v/s 70%, 22% of patients undernourished in both groups, 4% of patients severely undernourished in the observation group, v/s 8%. The INT introduced a daily calorie intake count for 100% of patients in the intervention group. Enteral nutrition via naso-gastric tube was carried out for 28% of the intervention group patient versus 0 in the observation group. The impact of intervention on the energy deﬁcit was as follows: elimination of the deﬁcit following completion of conditioning chemotherapy (day1 vs day5), constant maintenance of energy intakes during the neutropenia and engraftment period, but a tendency for over-intake of calories towards the end of hospitalization. Conclusion: The INT intervention in our unit lead to an improvement of nutritional support, with regard to standards and recommendations especially introduction of enteral nutrition through naso-gastric tube as ﬁrst line support. Disclosure of Interest: None Declared. N023 THE COMPETENT PATIENT IN A PAEDIATRIC STEM CELL TRANSPLANT UNIT (SCT): EXPERIMENTING A SYSTEM FOR THE SELF-EVALUATION OF DECISION-MAKING SKILLS IN ADOLESCENTS S. Calza*,1, 2, A. Bagnasco2, P. Petralia3, M. L. Sperlinga3, L. Fornoni3, C. Giorgia3, V. Giovanna3, G. Aleo2, C. Federica1, D. Marco1, O. Evelina1, E. Ghibaudo1, G. Morreale1, S. Del Buono3, U. Rosati3, B. D’ulivo1, L. Sasso2 1 Paediatric Haematology and Oncology, Giannina Gaslini Institute, 2Department of Health Science, University of Genoa, 3 Giannina Gaslini Institute, Genoa, Italy Introduction: The Barrows Cards method was originally used to test decision-making skills and critical thinking in medical students and which can be adapted, to assess the skills of competent patients. There is evidence that adolescents tend to have poor levels of compliance with prescribed treatments, so we used the Barrows Cards to stimulate compliance in adolescents affected by blood cancer and help them to autonomously and safely manage their drug therapy. The aim of the study is to improve compliance with therapeutic education in adolescents undergone to allogeneic Stem Cell Transplant (SCT). Method: The Barrows Cards method starts with a card that proposes an issue followed by pack of at least 15 cards each illustrating a possible decision. The front side of each card describes a particular behaviour, which could be either right or wrong. Instead, on the back of each card it says whether the behaviour chosen is right or wrong, and why. Adolescents are supported by a speciﬁcally-trained nurse, who explains them how to use the tool correctly and answers to their questions. Patients and their family members will then evaluate the tool by answering a short questionnaire on their level of satisfaction and on the Therapeutic Self Care Paediatric Scale before and after the intervention. Results: This tool has been successfully tested on 20 chronically-ill adolescents and all the indications that emerged from the test have been applied in corrective terms and an updated version is currently being tested. In addition, we are validating an English version of the method to facilitate therapeutic education with foreign patients
Conclusion: We conceived Barrow Cards method as a tool for adolescent patients before their discharge to teach them how to manage new medical aids and treatments. A portable computer or tablet made the tool more attractive and interactive. This tool aroused in adolescents a good level of interest and compliance, consequently contributing to a higher level of self-care educational efﬁcacy. Disclosure of Interest: None Declared. N024 ARCURLIM: CULINARY ART OR PLEASING CARE, THE RECIPES OF THE BONE MARROW TRANSPLANTED PATIENTS FROM LIMOUSIN COLLECTIVE PUBLICATION BY PATIENTS AND CARERS TO EASE THE RETURN TO HOME AFTER A TRANSPLANTATION. S. Monzat1, L. Tardieu*,1, C. Genty1, J. C. Salord2, D. Michaux2, F. Baudin2, N. Desbordes1, J. Abraham1, P. Turlure1, L. Remenieras1, S. Girault1, D. Bordessoule1 1 Hospital, 2chu limoges, Limoges, France Introduction: The National Days for transplant patients (P) organized by the French Society for Bone Marrow transplantation and Cellular Therapy present an opportunity for a moment of convivial sharing between carers and transplanted P. Beyond the regular schedule centred on the progress of grafting techniques and supportive care, the convivial atmosphere allows for more informal exchanges centred on the sharing of life experiences with former P and their friends and/ or close relatives, often ﬁlled with intense emotions. In March 2014, the spouse of a recently transplanted and home returnee patient called upon the audience, to ﬁnd solutions in order for her husband to regain a sense of taste as well as the desire to eat again. Claire S, spouse of JF, who received a graft more than a year prior, immediately rose to suggest her seafood risotto recipe, which had reconciled her husband with food. JF conﬁrmed that his taste had progressively returned, thanks to the culinary talents of his wife. Dominique, Nicolas, Franc¸oise had in turn suggested the recipes of nutritious cocktails, mouth-watering recipes, easy to swallow, as well as many little tips to revive damaged taste buds. So was born the project of a cookbook ARCURLIM )Culinary art or pleasing care, the recipes of the transplanted patients from Limousin*, intended to provide an educative support to future P once they return home. Method: A cross-profession Steering Committee(C) ARCURLIM gathering volunteers among the former patients and carers was put together. The implication of carers was immediate, be they from the grafting team or representatives from the coordination center 3CR-H or the Patients’ C. More than 5 P were actively present and participated not only in the crafting of recipes, but also to the illustrations of the book. Professional cooks enthusiastically rejoined the Steering C, be they cooks from the local hospital or P working in that ﬁeld. The main chefs of the Limousin were solicited to help the project by writing one recipe each following food recommendations.The book is comprised of 3 chapters:1:contains the post-graft food recommendations humorously illustrated, 2:presents the recipes shared by former P, 3:displays recipes from a few regional chefs. The funding of the project, which aimed at distributing 1000 free copies for the P, required the help of regional, associative, industrial partnerships, and enabled the publication of the book in October 2014. Conclusion: A prospective study will be conducted in order to evaluate the impact of illustrated food recommendations, the feasibility of the recipes and the help brought by this educational support, aiming at the improvement of the nutritional management of P with damaged taste buds after the graft as they return home. Disclosure of Interest: None Declared.
N025 FOOD SECURITY FOR PARENTS OF PAEDIATRIC BONE AND MARROW TRANSPLANT INPATIENTS AT THE CHILDREN’S HOSPITAL AT WESTMEAD R. Fisher*,1, J. Hewlett1, P. Wales1, P. Watson1, K. Montgomery1, M. Gabriel1 1 Oncology, The Children’s Hospital at Westmead, Westmead, Australia Introduction: Long lengths of stay and periods of isolation are synonymous with paediatric Bone and Marrow Transplantation (BMT) admissions as well as contributing factors to food insecurity for the patient’s main carer. The World Food Summit of 1996 deﬁned food security as existing ‘‘when all people at all times have access to sufﬁcient, safe, nutritious food to maintain a healthy and active life’’. Food insecurity exists when there is limited access and availability of nutritious and preferred foods. This research aimed to identify: 1) if and how the parent’s diets had changed during their child’s BMT admission, 2) the main barriers to the parent’s food security 3) recommendations to improve food security for parents of BMT inpatients at The Children’s Hospital at Westmead (CHW). Method: All English-speaking parents of BMT inpatients at the CHW from February 2014 to October 2014 were invited to participate in a prospective survey. The survey involved a selfadministered questionnaire used to identify changes in dietary patterns, food access and security during their child’s BMT admission. Results: Seventeen (89%) of the nineteen parents approached participated. Nine (53%) of the parents lived at least an hour
from the hospital. The patient’s hospital room was the main source of accommodation for all 17 parents during their child’s BMT admission. The survey found parents percieved a decrease in the nutritional quality of their diet whilst their child was an inpatient although their food expenses were higher. When asked to compare their diet during the BMT admission to their normal diet 59% reported eating smaller meals, 94% ate less fruit, 88% ate less vegetables, 82% ate less meat, 70% ate more snacks and 65% skipped meals more frequently. Fourteen parents (88%) reporting spending more on meals and 53% (n ¼ 9) of parents spent more on snack foods and drinks during this period. The main barriers identiﬁed by parents that inhibited food access included food costs, time spent in the patient’s room, lack of facilities and storage available in the patient’s room, access to ‘‘healthy food’’ and the need to care for their child. All the parents reported their child’s hospital meal was the main source of food for all of their main meals. Improved facilities in the patient’s room such as a microwave, crockery and cutlery as well as offering online shopping services and having better food outlets on the hospital premises were identiﬁed by most of the parents as being important to improve food security for this population. Conclusion: Parent’s of children undergoing a BMT are vulnerable to food insecurity. A multitude of barriers limited access to suitable foods resulting in a less nutritious diet during their child’s admission. By identifying these barriers and food access issues, changes can be implemented to improve food security for this population. Disclosure of Interest: None Declared.