Life situation in patients and their family members after allogeneic hematopoietic stem cell transplantation : aspects of health and support in different care settings

Allogeneic hematopoietic stem cell transplantation (HSCT) is mainly an intensive treatment option for hematology malignancies. During the past decades, improved care and treatment have been systematically developed. One example is the possibility for patients to choose to be at home rather than in the hospital during the early neutropenic phase after HSCT. Recent studies have shown positive medical advantages with home care. The overall aim of this thesis was to describe patients and family members’ life situation after HSCT, as well their experiences from two different care setting: the patient’s home or the hospital. Data from patient-reported experiences were used in studies I and II and patient reported- outcomes in study III. In study IV data from family members experiences were used. Data from 173 (study I n=41; study II n= 15; study III n= 117) patients and 14 family members (study IV) were included in the thesis.

In study I patients in both the hospital care group and the home care group expressed high satisfaction with the care and support during the acute post- transplantation phase.

In study II four categories were identified from the interviews with patients To be in a safe place, To have a supportive network, My way of taking control, and My uncertain way back to normal.

In study III, a cross-sectional survey was conducted and the majority of patients in both hospital care (77%) and home care (78%) rated their general health as ‘good’. A median of 14 symptoms were reported by patients in both hospital (0- 36) and home care (1-29). There were no significant differences regarding general health, symptom occurrence or self-efficacy between patients in hospital and those in home care.

In study IV interviews with family members generated a main category, Being me and being us in an uncertain time was identified and five generic categories To receive the information I need, To meet a caring organization, To be in different care settings, To be a family member, and To have a caring relationship.

In summary, numerous factors (the care routines, information, the competence and support from the health care team) related to the care were shown to influence the feeling of being safe regardless of care setting. Both patients and family members express the uncertainty associated with the HSCT. Different strategies (to have faith, being positive, hope and live in the present) were used to balancing the uncertainty. The majority of patients in both hospital care and home care rated their general health as ‘good’. A high symptom occurrence was reported in both groups in median five years post HSCT.

List of scientific papers

I. Bergkvist K, Larsen J, Johansson U-B, Mattsson J, Svahn B-M. Hospital care or home care after allogeneic hematopoietic stem cell transplantation – patients’ experiences of care and support. European Journal of Oncology Nursing 2013; 17(4):389-95.
https://doi.org/10.1016/j.ejon.2012.12.004

II. Bergkvist K, Fossum B, Johansson U-B, Mattsson J, Larsen J. Patients’ life situation during allogeneic hematopoietic stem cell transplantation – when care is given in different care settings. [Submitted]

III. Bergkvist K, Winterling J, Johansson E, Johansson U-B, Svahn B-M, Remberger M, Mattsson J, Larsen J. General health, symptom occurrence and self-efficacy in adult survivors after allogeneic hematopoietic stem cell transplantation: across-sectional comparison between hospital care and home care. Support Care Cancer 2015; 23(5):1273-1283.
https://doi.org/10.1007/s00520-014-2476-9

IV. Bergkvist K, Larsen J, Johansson U-B, Mattsson J, Fossum B. Being me and being us in an uncertain time – Family members’ experiences during allogeneic hematopoietic stem cell transplantation when care is given in the patient’s home or in hospital. [Submitted]