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The Mindfulness Pilot Project: The Effects of a Body Scan Activity on Bone Marrow Transplant Patients
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Abstracts / Biol Blood Marrow Transplant 25 (2019) S76 S99
(<1000) or long (>3000). Sites that generated the most engagement was from established medical journals and medical news sources. An analysis of 771 Facebook posts on GVHD with 163,555 engagements revealed that images and video posts generated the most engagements and that posts that were >300 characters generated more engagement. An analysis of questions asked online mentioning GVHD revealed that the most common topics were that of “experience” and sites of involvement (gut or skin). Discussion & Implications: Online articles and social networks have become integrated into our daily lives. It is important that we start to understand how these information sources are being used by patients, caregivers and health care providers. Our analysis of online engagement on the topic of GVHD is an example of how analytical programs can be used to help understand where and how people are engaging to learn and share their experiences with GVHD. TCT NURSING CONFERENCE
108 Shifting Gears from Transplant to CAR T: Creating a Cell Therapy Nurse Coordinator Role Elizabeth Hutnick BSN, RN, OCN1, Kathleen Ruehle RN, BMTCN2, Natalie Gahres BSN, RN1. 1 Blood and Marrow Transplant, University of Maryland Greenebaum Comprehensive Cancer Center, Baltimore, MD; 2 University of Maryland, Baltimore, MD Topic Significance & Study Purpose/Background/Rationale: With the advent of novel cell therapies such as chimeric antigen receptor (CAR)-T, blood and marrow transplant (BMT) programs find themselves in uncharted territory. While CAR-T shares some aspects with BMT, differences in patient care and program needs warrant the creation of a cellular therapy coordinator (CTC) role. This presentation aims to explore the unique development of the CTC role in an intermediate size transplant program providing commercial CAR-T therapy. Methods, Intervention, & Analysis: The CTC role resulted from extensive work by a multidisciplinary cell therapy team. The team created CAR-T focused standard operating procedures, and the CTC then translated these policies into direct patient care. While BMT policies have been long established, little precedent exists for CAR-T therapy. The CTC, in collaboration with the cell therapy team, created program-specific patient education publications, set documentation standards, and developed discharge planning tools. The CTC also created an adverse event reporting system as required by the FDA. In a variation from BMT, the CTC assumed responsibility for patient care coordination from the time of consent through the time of program discharge. This allowed for monitoring at all stages, and allowed the CTC to understand the nuances of each patient’s CAR-T experience. Findings & Interpretation: The program administered CAR-T cells to 17 patients over six months. Retrospective evaluation demonstrated several factors that differentiate the CTC role. Unlike BMT, manufactured CAR-T cells require oversight from pharmaceutical companies, insurance, and the FDA. The CTC maintains a relationship with the pharmaceutical companies through patient registration, event reporting, and facility audits. Since official billing codes do not exist, the CTC has an increased responsibility in the insurance approval process, working closely with financial coordinators and hospital administrators. The CTC also experiences challenges due to an acutely ill patient population. While most BMT patients are in remission, the relapsed/refractory CAR-T patients often require urgent treatment, adding additional time sensitivity to care coordination.
Discussion & Implications: As new trials and commercial products become available, cancer centers interested in pursuing cellular therapies should consider early implementation of cell therapy nurse coordinators. By understanding the nuances of cell therapy, a designated CTC ensures patient safety and enhance program development.
109 The Mindfulness Pilot Project: The Effects of a Body Scan Activity on Bone Marrow Transplant Patients Maggie Compernolle BSN, RN. 9800: Bone Marrow Transplant, Barnes Jewish Hospital, Saint Louis, MO Topic Significance & Study Purpose/Background/Rationale: Patients with hematological malignancies, particularly those with acute diagnoses requiring immediate treatment and hospitalization, often experience high levels of distress. Mindfulness has been shown to alleviate symptoms of distress in cancer patients, but there is limited research on the effects of mindfulness on distress in this inpatient population. The purpose of this pilot study is to determine the effects of a mindfulness intervention on symptoms of distress during inpatient hospitalizations for patients with hematological malignancies (HM). Methods, Intervention, & Analysis: A convenience sample of 30 patients with HM admitted to an oncology floor in a large, Midwestern hospital participated in this study. Participants completed the Rotterdam Symptom Checklist (RSCL): 30 physiological and psychological symptoms of distress, rating how much the symptoms bothered them during the past week on a Likert-type scale. Patients completed a 20-minute mindfulness activity including breathwork and the Body Scan in their rooms. Participants were given a summary sheet and practice log. The RSCL was again completed at two weeks. Patients were asked open-ended questions regarding their experience. Findings & Interpretation: A Wilcoxon Signed Rank Test revealed a statistically significant reduction in physiological and psychological distress at the two-week follow-up, z=4.12, p<0.05, with a large effect size (r=54), and z=2.16, p<0.05, with a small effect size (r=28), respectively. Change in quality of life score was not significant. Qualitative data also demonstrate value of the intervention, with patients reporting successful use of the intervention in falling asleep, reducing anxiety during an MRI, and reducing stress of follow-up appointments. Discussion & Implications: Patients expressed the desire for their care to include mindfulness interventions. This intervention is low-risk and low-cost and might be extended to include recorded mindfulness exercises or informal classes. Future studies might explore the use of different media such as audio recordings or phone apps for inpatient self-practice. After initial education of the Body Scan, nurses might encourage patients to utilize it while waiting for as-needed medications to be administered, before or during inpatient procedures, or in conjunction with medication to alleviate side effects of treatment. Doing so could empower patients during the course of their hospitalization, improving the patient experience.
110 Evaluating Nursing Readiness and Competency for Direct Patient Care after Initiation of New Pediatric CAR-T Cell Therapy Program Melanie Hankewycz APN, CPHON, CPNP-PC. Institute for Pediatric Cancer and Blood Disorders, Hackensack University Medical Center, Hackensack, NJ Topic Significance & Study Purpose/Background/Rationale: In March of 2018, a pediatric cellular therapy program was
Abstracts / Biol Blood Marrow Transplant 25 (2019) S76 S99
(<1000) or long (>3000). Sites that generated the most engagement was from established medical journals and medical news sources. An analysis of 771 Facebook posts on GVHD with 163,555 engagements revealed that images and video posts generated the most engagements and that posts that were >300 characters generated more engagement. An analysis of questions asked online mentioning GVHD revealed that the most common topics were that of “experience” and sites of involvement (gut or skin). Discussion & Implications: Online articles and social networks have become integrated into our daily lives. It is important that we start to understand how these information sources are being used by patients, caregivers and health care providers. Our analysis of online engagement on the topic of GVHD is an example of how analytical programs can be used to help understand where and how people are engaging to learn and share their experiences with GVHD. TCT NURSING CONFERENCE
108 Shifting Gears from Transplant to CAR T: Creating a Cell Therapy Nurse Coordinator Role Elizabeth Hutnick BSN, RN, OCN1, Kathleen Ruehle RN, BMTCN2, Natalie Gahres BSN, RN1. 1 Blood and Marrow Transplant, University of Maryland Greenebaum Comprehensive Cancer Center, Baltimore, MD; 2 University of Maryland, Baltimore, MD Topic Significance & Study Purpose/Background/Rationale: With the advent of novel cell therapies such as chimeric antigen receptor (CAR)-T, blood and marrow transplant (BMT) programs find themselves in uncharted territory. While CAR-T shares some aspects with BMT, differences in patient care and program needs warrant the creation of a cellular therapy coordinator (CTC) role. This presentation aims to explore the unique development of the CTC role in an intermediate size transplant program providing commercial CAR-T therapy. Methods, Intervention, & Analysis: The CTC role resulted from extensive work by a multidisciplinary cell therapy team. The team created CAR-T focused standard operating procedures, and the CTC then translated these policies into direct patient care. While BMT policies have been long established, little precedent exists for CAR-T therapy. The CTC, in collaboration with the cell therapy team, created program-specific patient education publications, set documentation standards, and developed discharge planning tools. The CTC also created an adverse event reporting system as required by the FDA. In a variation from BMT, the CTC assumed responsibility for patient care coordination from the time of consent through the time of program discharge. This allowed for monitoring at all stages, and allowed the CTC to understand the nuances of each patient’s CAR-T experience. Findings & Interpretation: The program administered CAR-T cells to 17 patients over six months. Retrospective evaluation demonstrated several factors that differentiate the CTC role. Unlike BMT, manufactured CAR-T cells require oversight from pharmaceutical companies, insurance, and the FDA. The CTC maintains a relationship with the pharmaceutical companies through patient registration, event reporting, and facility audits. Since official billing codes do not exist, the CTC has an increased responsibility in the insurance approval process, working closely with financial coordinators and hospital administrators. The CTC also experiences challenges due to an acutely ill patient population. While most BMT patients are in remission, the relapsed/refractory CAR-T patients often require urgent treatment, adding additional time sensitivity to care coordination.
Discussion & Implications: As new trials and commercial products become available, cancer centers interested in pursuing cellular therapies should consider early implementation of cell therapy nurse coordinators. By understanding the nuances of cell therapy, a designated CTC ensures patient safety and enhance program development.
109 The Mindfulness Pilot Project: The Effects of a Body Scan Activity on Bone Marrow Transplant Patients Maggie Compernolle BSN, RN. 9800: Bone Marrow Transplant, Barnes Jewish Hospital, Saint Louis, MO Topic Significance & Study Purpose/Background/Rationale: Patients with hematological malignancies, particularly those with acute diagnoses requiring immediate treatment and hospitalization, often experience high levels of distress. Mindfulness has been shown to alleviate symptoms of distress in cancer patients, but there is limited research on the effects of mindfulness on distress in this inpatient population. The purpose of this pilot study is to determine the effects of a mindfulness intervention on symptoms of distress during inpatient hospitalizations for patients with hematological malignancies (HM). Methods, Intervention, & Analysis: A convenience sample of 30 patients with HM admitted to an oncology floor in a large, Midwestern hospital participated in this study. Participants completed the Rotterdam Symptom Checklist (RSCL): 30 physiological and psychological symptoms of distress, rating how much the symptoms bothered them during the past week on a Likert-type scale. Patients completed a 20-minute mindfulness activity including breathwork and the Body Scan in their rooms. Participants were given a summary sheet and practice log. The RSCL was again completed at two weeks. Patients were asked open-ended questions regarding their experience. Findings & Interpretation: A Wilcoxon Signed Rank Test revealed a statistically significant reduction in physiological and psychological distress at the two-week follow-up, z=4.12, p<0.05, with a large effect size (r=54), and z=2.16, p<0.05, with a small effect size (r=28), respectively. Change in quality of life score was not significant. Qualitative data also demonstrate value of the intervention, with patients reporting successful use of the intervention in falling asleep, reducing anxiety during an MRI, and reducing stress of follow-up appointments. Discussion & Implications: Patients expressed the desire for their care to include mindfulness interventions. This intervention is low-risk and low-cost and might be extended to include recorded mindfulness exercises or informal classes. Future studies might explore the use of different media such as audio recordings or phone apps for inpatient self-practice. After initial education of the Body Scan, nurses might encourage patients to utilize it while waiting for as-needed medications to be administered, before or during inpatient procedures, or in conjunction with medication to alleviate side effects of treatment. Doing so could empower patients during the course of their hospitalization, improving the patient experience.
110 Evaluating Nursing Readiness and Competency for Direct Patient Care after Initiation of New Pediatric CAR-T Cell Therapy Program Melanie Hankewycz APN, CPHON, CPNP-PC. Institute for Pediatric Cancer and Blood Disorders, Hackensack University Medical Center, Hackensack, NJ Topic Significance & Study Purpose/Background/Rationale: In March of 2018, a pediatric cellular therapy program was