Validating the Positive Impact of In-Hospital Lay Care-Partner Support on Patient Survival in Allogeneic BMT

L.FosterLarry W. Foster, Ph.D., MSW, is a Professor within the School of Social Work, Cleveland State University. His academic focus is on teaching Ethics, Social Work in Health Care, and Human Behavior. His research primarily focuses on ethics and health care and psychosocial oncology, including impact of care-partner support on medical outcomes, particularly patient survival; psychosocial risk factors and the impact on post-transplant medical outcomes in bone marrow transplantation (BMT); and patient adjustment to illness in cancer care. He recently published a paper titled: ‘Validating the positive impact of in-hospital lay care-partner support on patient survival in allogeneic BMT: a prospective study’ in the journal Bone Marrow Transplantation.

Background of the study

My co-researchers noticed a clinical trend that allogeneic BMT patients having a consistent care-partner with them during the in-hospital stay for transplant had better medical outcomes, particularly survival. We conducted a retrospective study that revealed that having an inpatient lay care-partner associated with significantly improved patient survival. That not having a care-partner was comparable to biomedical risk factors, like remission status of disease, led to the five year prospective study which sought to validate this finding, as well as explore the impact of duration and frequency of the care-partner visits on patient survival.

Findings

Patients who had a care-partner (primarily their spouse/partner) with them during the bone marrow transplant hospitalization had significantly better survival; four-year and median survival are 42% and 36 months among patients with care-partners, compared to 26% and 10 months among those without care-partners. Better survival associates with care-partner visit duration of greater than 3 hours per day and with frequency of visits greater than 75% of inpatient days.

Implications

Care-partners need education pre-transplant about the optimal level of visitation and their importance in enabling their loved one to meaningfully place the illness and transplant experience in the context of their lives. Educating professional oncology staff, patients, and their lay care-partners, about the essential nature of a confiding and emotionally supportive relationship to the transplant experience and patient survival is important.

Also, it is important to develop care-partner support programs that encourage not only the presence of a care-partner, but also duration and frequency of visitation associating with optimal care-partner involvement and patient survival.

Additional research

In the future, developing interventions for patients without care-partner support is important with the goal of improving their survival rates. Future intervention based research could focus on increasing social supports for these patients by providing support groups, peer mentoring, counseling, and other psychosocial supportive services.

Increasing awareness

People believe in the value of having a supportive partner, but to see this belief verified in empirical research is important; warranted is going beyond professional venues to reach the lay public through mainstream media.

About the department

This research was a collaborative project between me, representing Cleveland State University, School of Social Work, and oncology health professionals at Cleveland Clinic Taussig Cancer Institute’s Bone Marrow Transplant Program. Together, we have developed and implemented an ongoing collaborative psychosocial oncology research program, focusing on improving quality of life and clinical outcomes for patients and families in bone marrow transplant.