A Standardized Nursing Intervention Protocol for HCT Patients
Changes in the health care system have resulted in shifting a significant portion of care to the home
environment where patients are responsible for care previously given by nurses in the acute care setting.
This shift is especially evident in hematopoietic cell transplant (HCT) patients who have life-threatening
disease and treatment and are acutely ill for months after hospital discharge. It is to this population that the
advanced practice nurse (APN) can bring considerable knowledge and skill. The overall goal of this
research is to improve outcomes for patients undergoing HCT by testing a Standardized Nursing Intervention
Protocol for HCT Patients that integrates interdisciplinary patient teaching content. The study aims and
hypotheses are to:
Aim 1. Test the effects of a Standardized Nursing Intervention Protocol (SNIP) on overall QOL,
(physical, psychological, social and spiritual well-being) and functional status for allogeneic HCT patients at
discharge, 3, 6, and 12 months post hospitalization as compared to allogeneic patients who receive usual
care plus attention control.
Aim 2: Test the effects of SNIP-HCT on secondary outcomes of time-to-first complication, total number of
complications, and mortality across groups.
Aim 3: Identify subgroups of patients who benefit most from the SNIP-HCT in relation to
sociodemographic characteristics, disease and clinical factors, and transplant factors.
Aim 4: Decompose the effect on the SNIP-HCT on QOLinto direct and indirect effects
This Phase II study is designed as alongitudinal single blind, randomized clinical trial for allogeneic HCT
patients. Theframework includes an adaptation ofMcCorkle's SNIP approach, expanded to apopulation
with numerous andpersistent physicalproblems, as well as psychosocial and spiritual challenges. A total of
352 eligible HCTpatients will be randomized to the SNIP-HCT or an attention control group. Thesix session
teaching content for the experimental group is given by an advancedpractice nurse in consultation with an
interdisciplinary advisory committee. Theexperimental group receives multiple home visits and telephone
calls for teaching and follow-up by an APN. Outcomes are evaluated at 3,6 and 12months post hospital
discharge. Thestudy builds on over ten years of research collaboration with an interdisciplinary HCT team.