scholarly journals Patient-centered care coordination in hematopoietic cell transplantation

2017 ◽  
Vol 1 (19) ◽  
pp. 1617-1627 ◽  
Author(s):  
Nandita Khera ◽  
Patricia Martin ◽  
Kristen Edsall ◽  
Anthony Bonagura ◽  
Linda J. Burns ◽  
...  
Keyword(s):  
Cell Transplantation ◽  
Care Coordination ◽  
Hematopoietic Cell Transplantation ◽  
Care Delivery ◽  
Treatment Options ◽  
Hematopoietic Cell ◽  
Coordinated Care ◽  
Patient Centered ◽  
Simplified Approach ◽  
Coordination Model

Abstract Hematopoietic cell transplantation (HCT) is an expensive, resource-intensive, and medically complicated modality for treatment of many hematologic disorders. A well-defined care coordination model through the continuum can help improve health care delivery for this high-cost, high-risk medical technology. In addition to the patients and their families, key stakeholders include not only the transplantation physicians and care teams (including subspecialists), but also hematologists/oncologists in private and academic-affiliated practices. Initial diagnosis and care, education regarding treatment options including HCT, timely referral to the transplantation center, and management of relapse and late medical or psychosocial complications after HCT are areas where the referring hematologists/oncologists play a significant role. Payers and advocacy and community organizations are additional stakeholders in this complex care continuum. In this article, we describe a care coordination framework for patients treated with HCT within the context of coordination issues in care delivery and stakeholders involved. We outline the challenges in implementing such a model and describe a simplified approach at the level of the individual practice or center. This article also highlights ongoing efforts from physicians, medical directors, payer representatives, and patient advocates to help raise awareness of and develop access to adequate tools and resources for the oncology community to deliver well-coordinated care to patients treated with HCT. Lastly, we set the stage for policy changes around appropriate reimbursement to cover all aspects of care coordination and generate successful buy-in from all stakeholders.

scholarly journals National Survey of Hematopoietic Cell Transplantation Center Personnel, Infrastructure, and Models of Care Delivery

2015 ◽  
Vol 21 (7) ◽  
pp. 1308-1314 ◽  
Author(s):  
Navneet S. Majhail ◽  
Lih-Wen Mau ◽  
Pintip Chitphakdithai ◽  
Tammy Payton ◽  
Michael Eckrich ◽  
...  
Keyword(s):  
Cell Transplantation ◽  
National Survey ◽  
Hematopoietic Cell Transplantation ◽  
Care Delivery ◽  
Models Of Care ◽  
Hematopoietic Cell ◽  
Transplantation Center

Metacommunication process during a 3-day digital storytelling workshop for patients recovering from hematopoietic cell transplantation

2020 ◽  
Vol 30 (2) ◽  
Keyword(s):  
Cell Transplantation ◽  
Digital Storytelling ◽  
Hematopoietic Cell Transplantation ◽  
Hematopoietic Cell ◽  
Constructivist Grounded Theory ◽  
Cancer Center ◽  
Theory Approach ◽  
Patient Centered ◽  
Team Members ◽  
Phoenix Metropolitan Area

Abstract Purpose: The purpose of this study was to qualitatively analyze metacommunication during the digital storytelling (DST) workshop process for patients undergoing hematopoietic cell transplantation (HCT). Methods: HCT survivors who had undergone transplant within the past 2 years were recruited at a cancer center in the Phoenix Metropolitan area. Participants (M age = 51.5 years) attended a 3-day DST workshop telling and creating digital stories around their HCT experiences. Using a constructivist grounded theory approach, line by line coding and content analysis were conducted with four research team members. Results: Four themes emerged from the data: (1) communal connection; (2) expressing and processing emotions; (3) self-empowerment; and (4) multi-dimensional coping. Participants described telling and sharing their story with other HCT patients as therapeutic. Conclusion: DST shows promise as a potential coping tool and offers multiple dimensions of the role of narrative as a coping technique, in community building, and in patient-centered contexts within HCT.

Old and New Cancers after Hematopoietic-Cell Transplantation

Hematology ◽  
2008 ◽  
Vol 2008 (1) ◽  
pp. 142-149 ◽  
Author(s):  
Navneet S. Majhail
Keyword(s):  
Cell Transplantation ◽  
Hematopoietic Cell Transplantation ◽  
Residual Disease ◽  
Treatment Options ◽  
Hematologic Malignancies ◽  
Donor Lymphocyte Infusion ◽  
Hematopoietic Cell ◽  
Second Cancers ◽  
Post Transplant ◽  
Allogeneic Hct

Abstract Relapse of primary disease and occurrence of new cancers can cause significant morbidity and mortality in recipients of autologous and allogeneic hematopoietic-cell transplantation (HCT). Treatment options for relapse are generally limited and can include disease-specific chemotherapy or targeted therapy. Additional relapse-directed therapies that are available for allogeneic HCT recipients include withdrawal of immunosuppression and donor lymphocyte infusion. Selected patients can be offered a second transplant procedure. Newer strategies to eliminate minimal residual disease and, in allogeneic HCT recipients, to augment the graft-versus-tumor effect are needed for patients who are at high risk for relapse after HCT. Second cancers after HCT include post-transplant lymphoproliferative disorder, hematologic malignancies and new solid cancers. The incidence of second solid cancers continues to rise without a plateau with increasing follow up of HCT survivors. Secondary myelodysplastic syndrome and acute leukemia are almost exclusively seen in autologous HCT recipients while post-transplant lymphoproliferative disorders complicate recipients of allogeneic HCT. Appropriate screening evaluations should be performed in HCT survivors to facilitate early detection and treatment of second cancers.

Team Cognition As a Means to Improve Care Delivery in Critically Ill Patients With Cancer After Hematopoietic Cell Transplantation

2016 ◽  
Vol 12 (11) ◽  
pp. 1091-1099 ◽  
Author(s):  
Nathan J. McNeese ◽  
Nandita Khera ◽  
Sara E. Wordingham ◽  
Noel Arring ◽  
Sharon Nyquist ◽  
...  
Keyword(s):  
Cell Transplantation ◽  
Cognitive Processing ◽  
Hematopoietic Cell Transplantation ◽  
Care Delivery ◽  
Clinical Care ◽  
Multidisciplinary Care ◽  
Hematologic Malignancies ◽  
Poor Quality ◽  
Hematopoietic Cell ◽  
Team Cognition

Hematopoietic cell transplantation (HCT) is an important and complex treatment modality for a variety of hematologic malignancies and some solid tumors. Although outcomes of patients who have undergone HCT and require care in intensive care units (ICUs) have improved over time, mortality rates remain high and there are significant associated costs. Lack of a team-based approach to care, especially during critical illness, is detrimental to patient autonomy and satisfaction, and to team morale, ultimately leading to poor quality of care. In this manuscript, we describe the case of a patient who had undergone HCT and was in the ICU setting, where inconsistent team interaction among the various stakeholders delivering care resulted in a lack of shared goals and poor outcomes. Team cognition is cognitive processing at the team level through interactions among team members and is reflected in dynamic communication and coordination behaviors. Although the patient received multidisciplinary care as needed in a medically complicated case, a lack of team cognition and, particularly, inconsistent communication among the dynamic teams caring for the patient, led to mixed messages being delivered with high-cost implications for the health-care system and the family. This article highlights concepts and recommendations that begin a necessary in-depth assessment of implications for clinical care and initiate a research agenda that examines the effects of team cognition on HCT teams, and, more generally, critical care of the patient with cancer.

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