Clinicians and patients perspectives on follow-up care and eHealth support after allogeneic hematopoietic stem cell transplantation: A mixed-methods contextual analysis as part of the SMILe study

Lynn Leppla; Juliane Mielke; Maria Kunze; Oliver Mauthner; Alexandra Teynor; Sabine Valenta; Jasper Vanhoof; Fabienne Dobbels; Lut Berben; Robert Zeiser; Monika Engelhardt; Sabina De Geest; SMILe study team

doi:10.1016/j.ejon.2020.101723

Clinicians and patients perspectives on follow-up care and eHealth support after allogeneic hematopoietic stem cell transplantation: A mixed-methods contextual analysis as part of the SMILe study

Eur J Oncol Nurs. 2020 Apr:45:101723. doi: 10.1016/j.ejon.2020.101723. Epub 2020 Jan 22.

Authors

Affiliations

¹ Institute of Nursing Science, Department Public Health, University of Basel, Switzerland; Department of Medicine I, Medical Center - University of Freiburg, Faculty of Medicine, University of Freiburg, Germany.
² Institute of Nursing Science, Department Public Health, University of Basel, Switzerland.
³ Department of Medicine I, Medical Center - University of Freiburg, Faculty of Medicine, University of Freiburg, Germany; Department of Psychiatry and Psychotherapy, University of Freiburg, Germany.
⁴ University of Applied Sciences Augsburg, Faculty of Computer Science, Germany.
⁵ Institute of Nursing Science, Department Public Health, University of Basel, Switzerland; Department of Hematology, University Hospital Basel, Switzerland.
⁶ Academic Centre for Nursing and Midwifery, Department of Public Health and Primary Care, KU Leuven, Belgium; Nursing Center of Excellence, University Psychiatric Center, KU Leuven, Belgium.
⁷ Institute of Nursing Science, Department Public Health, University of Basel, Switzerland; Academic Centre for Nursing and Midwifery, Department of Public Health and Primary Care, KU Leuven, Belgium.
⁸ Department of Medicine I, Medical Center - University of Freiburg, Faculty of Medicine, University of Freiburg, Germany.
⁹ Institute of Nursing Science, Department Public Health, University of Basel, Switzerland; Academic Centre for Nursing and Midwifery, Department of Public Health and Primary Care, KU Leuven, Belgium. Electronic address: [email protected].

PMID: 32062362
DOI: 10.1016/j.ejon.2020.101723

Abstract

Purpose: We report on our contextual analysis's methodology, as a first step of an implementation science project aiming to develop, implement, and test the effectiveness of an integrated model of care in SteM-cell transplantatIon faciLitated by eHealth (SMILe).

Methods: We applied an explanatory sequential mixed-methods design including clinicians and patients of the University Hospital Freiburg, Germany. Data were collected from 3/2017 to 1/2018 via surveys in 5 clinicians and 60 adult allogeneic stem-cell transplantation patients. Subsequently, we conducted 3 clinician focus groups and 10 patient interviews. Data analysis followed a 3-step process: (1) creating narrative descriptions, tables, and maps; (2) mapping key observational findings per dimension of the eHealth-enhanced Chronic-Care Model; (3) reflecting on how findings affect our choice of implementation strategies.

Results: Current clinical practice is mostly acute care driven, with no interdisciplinarity and weak chronic illness management. Gaps were apparent in the dimensions of self-management support and delivery-system design. Health behaviors that would profit from support include medication adherence, physical activity and infection prevention. The theme "being alone and becoming an expert" underpinned patients need to increase support in hospital-to-home transitions. Patients reported insecurity about recognizing, judging and acting upon symptoms. The theme "eHealth as connection not replacement" underscores the importance of eHealth augmenting, not supplanting human contact. Synthesis of our key observational findings informed eight implementation strategies.

Conclusion: Stakeholders are willing towards a chronic care-focused approach and open for eHealth support. The contextual information provides a basis for the SMILe model's development and implementation.

Keywords: Allogeneic stem cell transplantation; Chronic care model; Contextual analysis; Implementation science; Integrated care; User-centered design; eHealth.

MeSH terms

Adult
Aftercare / psychology*
Aftercare / statistics & numerical data
Aged
Chronic Disease / rehabilitation*
Female
Deutschland
Health Personnel / psychology
Health Personnel / statistics & numerical data
Hematopoietic Stem Cell Transplantation / psychology*
Humans
Male
Middle Aged
Patient Satisfaction / statistics & numerical data*
Self-Management / methods*
Self-Management / psychology*
Telemedicine / methods*
Telemedicine / statistics & numerical data
Young Adult