Group psychological intervention for emotional distress in haematopoietic stem cell transplantation: A feasibility randomised clinical trial

Michael Baliousis; Michael Rennoldson; David L Dawson; Roshan das Nair

doi:10.1016/j.ejon.2023.102359

Group psychological intervention for emotional distress in haematopoietic stem cell transplantation: A feasibility randomised clinical trial

Eur J Oncol Nurs. 2023 Aug:65:102359. doi: 10.1016/j.ejon.2023.102359. Epub 2023 Jun 7.

Authors

Michael Baliousis¹, Michael Rennoldson², David L Dawson³, Roshan das Nair⁴

Affiliations

¹ School of Psychology, University of Lincoln, Lincoln, UK. Electronic address: mbaliousis@lincoln.ac.uk.
² Department of Clinical Psychology and Neuropsychology, Nottingham University Hospitals, Nottingham, UK.
³ School of Psychology, University of Lincoln, Lincoln, UK.
⁴ School of Medicine, Institute of Mental Health, University of Nottingham, Nottingham, UK; SINTEF Digital, Norway.

PMID: 37315352
DOI: 10.1016/j.ejon.2023.102359

Abstract

Purpose: Haematopoietic stem cell transplantation (HSCT) is an intensive procedure associated with elevated psychological distress, particularly during the initial stages. Based on self-regulatory theory, a prophylactic group intervention was developed to mitigate this distress by targeting perceptions of HSCT and coping. This study evaluated the feasibility of delivering the intervention and of conducting a randomised clinical trial to assess efficacy.

Methods: Adults from consecutive referrals at two transplant centres were randomised to the intervention or to treatment as usual at each site. Psychological distress (primary outcome), HSCT perceptions, and coping were assessed at baseline, on transplant day, and two and four weeks after transplantation.

Results: Of 99 eligible patients, 45 consented. Main barriers to consent were insufficient time prior to transplantation, competing priorities, being unwell, and travel distance. Of 21 participants randomised to the intervention, five attended. Main barriers to attendance included insufficient time prior to transplantation and having competing priorities. Groups could not be held sufficiently frequently to enable attendance prior to transplantation, as randomising participants to the control group limited accrual. Anxiety peaked two weeks following transplantation. Depression increased throughout the acute phase. Clinical levels of distress were observed in 42% of patients during HSCT. Intervention effects were small but sample sizes for a full trial appeared feasible.

Conclusions: Multimodal prehabilitation is required but there are specific barriers to delivering a group-based intervention and conducting a trial. Group prehabilitation requires customisation and better integration with routine care, such as patient screening, personalisation, and options for remote delivery.

Keywords: Bone marrow transplantation; Cancer; Prehabilitation; Psychological distress; Psychosocial intervention; Stem cell transplantation.

Publication types

Randomized Controlled Trial

MeSH terms

Adult
Depression / psychology
Feasibility Studies
Hematopoietic Stem Cell Transplantation* / adverse effects
Hematopoietic Stem Cell Transplantation* / psychology
Humans
Psychological Distress*
Psychosocial Intervention