Identifying the Need for a Regional Nurse–Led Allogeneic Haematopoietic Stem Cell Transplant (allo-HSCT) Late Effects Follow up Program

Topic Significance & Study Purpose/Background/Rationale: Advances in allo-HSCT technologies have improved survival in patients. Wingard (2011) identified allo-HSCT recipients alive at 2 years post allo-HSCT had an 80-92% survival at 10 years. As a result patients experience chronic and late complications of transplant requiring lifelong surveillance (Gifford 2013). Calvary Mater Newcastle (CMN) refers 15-20 patients per annum for allo-HSCT. The increasing numbers of survivors >2 years post allo-HSCT are not able to be accommodated in the standard allo-HSCT follow up clinics. A need was identified to provide a model of care for long term survivors of allo-HSCT. A nurse-led approach was seen as a potential solution, a model supported by a steady growth in literature (Gates 2009).

Methods, Intervention, & Analysis: Clinics were established and coordinated by the BMT nurse coordinator, assisted by a haematology fellow and conducted parallel to the standard BMT clinic. Eligible patients were: more than 2 years post allo-HSCT, with no ongoing graft versus host disease (GvHD), in remission and requiring annual follow up. Patients were required to complete certain tests & screens prior to their appointment in accordance with recognised long term follow up (LTFU) guidelines. The survivorship care plan (SCP) specifically designed to address long term health issues in post allo-HSCT patients of the major centre where patients are referred for allo-HSCT (Westmead Hospital) was used. Patients were provided with a copy of their SCP.

Findings & Interpretation: 60 patients were eligible to attend the clinic. The SCP provided an excellent framework for education, screening, prevention, improving co-ordinated care & communication. Greater nurse involvement in the clinic was identified as a key factor in improving continuity and patient centred care. However, trying to coordinate the LTFU clinics alongside the standard BMT clinic was found to be not feasible, due to staffing constraints. Therefore, planning is now proceeding to make the LTFU clinic run independent of the standard BMT clinic and be nurse-led.

Discussion & Implications: In Australia nurse –led follow up in allo-HSCT is emerging (Gates 2009). The benefits of a localised nurse-led late effects program ensures patient compliance with ongoing health surveillance, overall better patient outcomes by reducing patient travel for similar follow up in metropolitan centres.