Protective Isolation for Patients with Haematological Malignancies: A Pilot Study Investigating Patients’ Distress and Use of Time


Background: Patients with haematological malignancies are often hospitalized in protective isolation until full neutrophil recovery in order to prevent infections. This descriptive pilot study evaluate the level of isolation-related distress and the use of free time in a sample of Italian onco-haematological patients who were hospitalized in protective isolation.
Materials and Methods: Participants were 18 patients hospitalized in hematologic ward to receive induction therapy (n=12) or autologous stem cell transplant (n=6). They completed a self-report questionnaire before discharge.
Results: Participants reported a moderate level of isolation-related distress, anxiety, and boredom: the more the anxiety and the boredom, the more the distress (r=.77; P<.001), (r=.79; P<.001), respectively. The activities performed during isolation were: watching TV (72.2%), reading (55.6%), thinking (33.3%), surfing in Internet or using PC (33.3%), and playing games or making cross-words (16.7%). Participants who reported pessimistic thinking had higher isolation-related distress (P=.004) as well as anxiety (P<.001) and boredom (P=.001).
Conclusion: Haematology Units should support isolated patients in spending their time in recreational activities, allowing more contacts with immediate relatives and friends, providing free TV and Wi-Fi connection inside the room. In addition, patients should have to keep themselves physically active. Isolation-related distress could also be reduced by providing psychological support.

Saria M. Preventing and managing infections in neutropenic stem cell transplantation recipients: evidence-based review. Clin J Oncol Nurs. 2011; 15(2):133-9

Yokoe D, Casper C, Dubberke E, et al. Infection prevention and control in health-care facilities in which hematopoietic cell transplant recipients are treated. Bone Marrow Transplant. 2009. 44(8): 495-507.

Vokurka S, Bystrická E, Svoboda T, et al. The availability of HEPA-filtered rooms and the incidence of pneumonia in patients after haematopoietic stem cell transplantation (HSCT): results from a prospective, multicentre, eastern European study. J Clin Nurs. 2014; 23(11-12):1648-52

Mank A, van der Lelie H. Is there still an indication for nursing patients with prolonged neutropenia in protective isolation? An evidence-based nursing and medical study of 4 years experience for nursing patients with neutropenia without isolation. Eur J Oncol Nurs. 2003; 7(1): 17-23.

Caselli D, Cesaro S, Livadiotti S, et al. Preventing transmission of infectious agents in the pediatric in-patients hematology-oncology setting: What is the role for non-pharmacological prophylaxis? Pediatr Rep. 2011; 3(1):e9.

Hayes-Lattin B, Leis JF, Maziarz RT. Isolation in the allogeneic transplant environment: How protective is it? Bone Marrow Transplant. 2005; 36(5):373-81

Ariza-Heredia EJ, Chemaly RF. Infection control practices in patients with hematological malignancies and multidrug-resistant organisms: Special considerations and challenges. Clin Lymphoma Myeloma Leuk. 2014; 14 Suppl: S104-10.

Bevans M, Tierney DK, Bruch C, et al. Hematopoietic stem cell transplantation nursing: a practice variation study. Oncol Nurs Forum. 2009; 36(6):E317-25.

Hicheri Y, Einsele H, Martino R, et al. Environmental prevention of infection in stem cell transplant recipients: a survey of the Infectious Diseases Working Party of the European Group for Blood and Marrow Transplantation. Transpl Infect Dis. 2013; 15(3):251-8.

Lee SJ, Astigarraga CC, Eapen M, et al. Variation in supportive care practices in hematopoietic cell transplantation. Biology of Blood and Marrow Transplantation; 2008. 14(11): 1231-38.

Tecchio C, Bonetto C, Bertani M, et al. Predictors of anxiety and depression in hematopoietic stem cell transplant patients during protective isolation. Psycho-Oncology; 2013. 22(8): 1790-7.

Prieto JM, Atala J, Blanch J, et al. Patient-rated emotional and physical functioning among hematologic cancer patients during hospitalization for stem-cell transplantation. Bone Marrow Transplant. 2005; 35(3): 307-14.

Vottero B, Rittenmeyer L. The hospitalised patients’ experience of being in protective/source isolation: a systematic review of qualitative evidence. JBI Libr Syst Rev. 2012; 10(16):935-976

Biagioli V, Piredda M, Alvaro R, et al. The experiences of protective isolation in patients undergoing bone marrow or haematopoietic stem cell transplantation: systematic review and metasynthesis. Eur J Cancer Care (Engl). 2017; 26(5).

Dunn E, Arber A, Gallagher A. The immediacy of illness and existential crisis: patients' lived experience of under-going allogeneic stem cell transplantation for haematological malignancy. A phenomenological study. Eur J Oncol Nurs. 2016; 21:90-6

Zamanzadeh V, Valizadeh L, Sayadi L, et al. Life in limbo: experiences of Iranian hematopoietic stem cell transplantation recipient patients and nurses in a qualitative study. Int J Hematol Oncol Stem Cell Res. 2013; 7(3):25-33.

Biagioli V, Piredda M, Mauroni MR, et al. The lived experience of patients in protective isolation during their hospital stay for allogeneic haematopoietic stem cell transplantation. Eur J Oncol Nurs. 2016; 24: 79-86

Tichelli A, Labopin M, Rovó A, et al. Increase of suicide and accidental death after hematopoietic stem cell transplantation: A cohort study on behalf of the Late Effects Working Party of the European Group for Blood and Marrow Transplantation (EBMT). Cancer; 2013. 119(11): 2012-21.

Molassiotis A. Further evaluation of a scale to sceen for risk of emotional difficulties in bone marrow transplant recipients. J Adv Nurs. 1999; 29(4):922-7.

Faucher C, Le Corroller Soriano AG, Esterni B, et al. Randomized study of early hospital discharge following autologous blood SCT: medical outcomes and hospital costs. Bone marrow transplant; 2012. 47(4): 549-55.

Bergkvist K, Larsen J, Johansson UB, et al. Hospital care or home care after allogeneic hematopoietic stem cell transplantation – Patients' experiences of care and support. Eur J Oncol Nurs. 2013; 17(4):389-95.

Fernández-Avilés F, Carreras E, Urbano-Ispizua A, et al. Case-control comparison of at-home to total hospital care for autologous stem-cell transplantation for hematologic malignancies J Clin Oncol. 2006; 24(30): 4855-61.

Paul TM, Liu SV, Chong EA, et al. Outpatient autologous stem cell transplantation for patients with myeloma. Clin Lymphoma Myeloma Leuk. 2015; 15(9):536-40.

Mank AP, Schoonenberg C, Bleeker K, et al. Early discharge after high dose chemotherapy is safe and feasible: a prospective evaluation of 6 years of home care. Leuk Lymphoma. 2015; 56(7):2098-104

Schulmeister L, Quiett K, Mayer K. Quality of life, quality of care, and patient satisfaction: perceptions of patients undergoing outpatient autologous stem cell transplantation. Oncol Nurs Forum. 2005; 32(1):57-67.

Svendsen L.F.H. A philosophy of boredom. 6th edn. Reaktion Books: London, UK, 2005.

Karhe L, Kaunonen M. Patient experiences of loneliness: An evolutionary concept analysis. ANS Adv Nurs Sci. 2015; 38(4):E21-34.

Ustinova KI, Leonard WA, Cassavaugh ND, et al. Development of a 3D immersive videogame to improve arm-postural coordination in patients with TBI. J Neuroeng Rehabil. 2011; 8:61.

Sasaki T, Akaho R, Sakamaki H, et al. Mental disturbances during isolation in bone marrow transplant patients with leukemia. Bone Marrow Transplant. 2000; 25(3):315-8.

Beattie S, Lebel S, Tay J. The influence of social support on hematopoietic stem cell transplantation survival: a systematic review of literature. PLoS One. 2013; 8(4): e61586.

Bergenthal N, Will A, Streckmann F, et al. Aerobic physical exercise for adult patients with haematological malignancies. Cochrane Database Syst Rev. 2014 ;( 11):CD009075

Van Haren IE, Timmerman H, Potting CM, et al. Physical exercise for patients undergoing hematopoietic stem cell transplantation: systematic review and meta-analyses of randomized controlled trials. Phys Ther. 2013; 93(4):514-28.

Saposnik G, Mamdani M, Bayley M, et al. Effectiveness of virtual reality using Wii gaming technology in stroke rehabilitation. Int J Stroke. 2010; 5(1):47-51.

IssueVol 11, No 4 (2017) QRcode
Patient isolation Social isolation Hematopoietic stem cell transplantation Time perception

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How to Cite
Annibali O, Pensieri C, Tomarchio V, Biagioli V, Pennacchini M, Tendas A, Tambone V, Tirindelli MC. Protective Isolation for Patients with Haematological Malignancies: A Pilot Study Investigating Patients’ Distress and Use of Time. Int J Hematol Oncol Stem Cell Res. 2017;11(4):313-318.