Psychological distress in patients undergoing allogeneic hematopoietic stem cell transplantation (alloHSCT) affects overall survival and quality of life, yet nurses have no standard of practice to follow for their psychological assessment, ONS members Brooke E. Trigiani, RN, MSN, OCN®, and Carolee Polek, PhD, RN, AOCNS®, BMTCN®, reported in the February 2024 issue of the Clinical Journal of Oncology Nursing.
A lifesaving but invasive and traumatic treatment, alloHSCT uses chemotherapy and radiation therapy to ablate patients’ existing bone marrow and destroy their diseased immune system. Then, patients are transfused with stem cells harvested from a donor match that become their bone marrow, creating a new immune system free from malignancy.
For their comprehensive clinical literature review, Trigiani and Polek investigated the current standard practice and outcomes for psychological assessment and identified the impact of psychological distress and psychological disorders on overall survival rates and outcomes in patients receiving alloHSCT. They conducted an extensive literature search for studies published from 2013–2023 that involved patients undergoing alloHSCT, psychiatric and/or psychosocial assessment, and measurable outcomes, including quality of life, readmission, and mortality, and presented the evidence for 12 studies.
They found that clinicians used various validated instruments to measure psychological distress among patients undergoing alloHSCT, including the Hospital Anxiety and Depression Scale, Patient Health Questionnaire–9, Post-Traumatic Stress Disorder Checklist, and an adapted Transplant Evaluation Rating Scale. Additionally, patients who identified as male had a higher risk for developing psychological disorders compared to those who identified as female “and may need additional intervention or diligent assessment to manage psychological care.”
In previous study reports about patients undergoing alloHSCT, researchers have linked psychological distress to worse quality of life and overall survival. “Patients who had psychological assessment with poor psychological findings had lower overall survival rates,” the authors reported. However, to date, oncology nurses and other clinicians have no standard of practice for psychological assessment of alloHSCT recipients.
“Patient advocacy is central to the role of oncology nurses. [Advocating for] a process for standardized psychological assessment of patients undergoing alloHSCT can help promote psychological interventions for this vulnerable patient population,” Trigiani and Polek said.
“Based on the findings from this review, there is a need for an optimal psychological assessment tool for patients undergoing alloHSCT to provide long-term psychological care for this vulnerable patient population,” Trigiani and Polek concluded. Validated assessment tools that have shown high efficacy in predicting psychological distress in patients receiving alloHSCT include the Psychosocial Assessment of Candidates for Transplantation Scale and the Transplant Evaluation Rating Scale.
Oncology nurses can organize projects to validate the effectiveness of psychological assessment tools in patients undergoing alloHSCT and develop targeted interventions to enhance patient outcomes, including support groups, medication or other forms of therapy, and collaborating for community support.