Quality of life, quality of care, and patient satisfaction: Perceptions of patients undergoing outpatient autologous stem cell transplantation

Purpose/Objectives: To further expand the limited body of knowledge of the perceptions of quality of life (QOL), quality of care, and patient satisfaction among patients who receive high-dose chemotherapy with an autologous stem cell transplant (ASCT) on an outpatient basis. Design: Descriptive longitudinal. Setting: Nine clinical sites associated with a national oncology practice management network in locations across the United States. Sample: 36 patients scheduled to receive high-dose chemotherapy with ASCT selected by nonprobability consecutive sampling. Methods: Subjects completed the Functional Assessment of Cancer Therapy-Bone Marrow Transplant (FACT-BMT) before high-dose chemotherapy, four to six weeks postchemotherapy, and six months postchemotherapy. An independent nurse researcher conducted telephone interviews about the treatment experience, perceptions of quality of care, and satisfaction with care. FACT-BMT data were analyzed using descriptive statistics and multivariate analysis of variance, and qualitative data about perceptions of care were analyzed using Giorgi's methodologic reduction. Bivariate associations were made between overall degree of satisfaction with care and QOL as measured by the FACT-BMT. Main Research Variables: Clinical outcome, QOL, patient satisfaction, and patient perceptions of care quality. Findings: Mean FACT-BMT scores were lower one month post-treatment than at baseline and highest six months post-treatment. Subjects with progressive disease reported lower QOL at one and six months post-treatment, noted more complaints, and ranked their satisfaction with care lower than subjects with no evidence of disease. Subjects offered ASCT program improvement recommendations in the areas of communication, information, nursing care, ancillary needs assistance, ancillary agencies, and survivor support. Conclusions: In this study, the QOL of patients undergoing outpatient high-dose chemotherapy with ASCT decreased post-treatment but increased to levels higher than those found at pretreatment by six months. A good clinical outcome following high-dose chemotherapy and ASCT was associated with higher QOL and greater satisfaction with care. Implications for Nursing: Knowledge of the outpatient ASCT experience and its effect on QOL can be used to further refine the content and timing of educational and supportive interventions for patients undergoing ASCT. Information about patients' satisfaction with treatment and perceptions of quality of care provides insight about their expectations and perceived needs and can be used to redesign outpatient ASCT programs.