The Relative Importance of Inpatient Lay Care-Partners to Patient Illness Adjustment in Allogeneic BMT

Previously we reported a retrospective study describing the positive impact of having an inpatient lay care-partner (CP) on patient survival in allogeneic BMT. To better explain this phenomenon we launched a prospective study comparing illness adjustment between allo BMT patients with and without an inpatient lay CP. Study patients were a subset of acute leukemia patients from a larger prospective study (N = 164) that verified patients with a CP had significantly better rates of survival (P = 0.017). Of the 32 enrolled patients, 17 had a CP; 15 did not. Utilizing a modes of illness adjustment (MIA) interview schedule, patients were interviewed pre-admission and 100 days post-transplant by a social worker; taped interviews were scored by two other social workers. The Psychosocial Assessment of Candidate for Transplant (PACT) Scale was completed by the social worker. Patients completed FACT-BMT (quality of life), Profile of Mood States-Short Form (POMS), and Brief COPE.Majority of CPs were female, a spouse or parent, and were with patients a median of 7 hours a day and a median of 85% of inpatient days. There were no significant differences between patients with and without CPs on patient demographics and medical variables. Patients with a CP had significantly better scores on the initial PACT scale rating of candidate quality for transplant (P = 0.022) and on sub-scale of family or support system availability (P = ≤ 0.001).Illness adjustment included four modes: accommodation, secondary gains, denial, resignation, and two summed variables: accommodation + secondary gains and denial + resignation. Variables did not differ significantly between groups at baseline, although at post-transplant resignation (P = 0.009) and denial + resignation (P = 0.036) were significantly smaller among patients with no CP. Also, from pre- to post-transplant, denial (P = 0.049) and denial + resignation (P = 0.044) decreased among patients without a CP, suggesting these patients may have become less oppositional in adjusting to illness.MIA did not correlate significantly with patient survival but survival correlated significantly with CP presence (P = 0.039) and CP frequency > 75% (P = 0.019). MIA correlated significantly with select items on FACT-BMT, POMS, and Brief COPE. Better scores on these scales associated with complimentary MIA and worse scores associated with oppositional MIA. Essential is a support program for patients as well as CPs to improve quality and outcome of the BMT experience. Previously we reported a retrospective study describing the positive impact of having an inpatient lay care-partner (CP) on patient survival in allogeneic BMT. To better explain this phenomenon we launched a prospective study comparing illness adjustment between allo BMT patients with and without an inpatient lay CP. Study patients were a subset of acute leukemia patients from a larger prospective study (N = 164) that verified patients with a CP had significantly better rates of survival (P = 0.017). Of the 32 enrolled patients, 17 had a CP; 15 did not. Utilizing a modes of illness adjustment (MIA) interview schedule, patients were interviewed pre-admission and 100 days post-transplant by a social worker; taped interviews were scored by two other social workers. The Psychosocial Assessment of Candidate for Transplant (PACT) Scale was completed by the social worker. Patients completed FACT-BMT (quality of life), Profile of Mood States-Short Form (POMS), and Brief COPE. Majority of CPs were female, a spouse or parent, and were with patients a median of 7 hours a day and a median of 85% of inpatient days. There were no significant differences between patients with and without CPs on patient demographics and medical variables. Patients with a CP had significantly better scores on the initial PACT scale rating of candidate quality for transplant (P = 0.022) and on sub-scale of family or support system availability (P = ≤ 0.001). Illness adjustment included four modes: accommodation, secondary gains, denial, resignation, and two summed variables: accommodation + secondary gains and denial + resignation. Variables did not differ significantly between groups at baseline, although at post-transplant resignation (P = 0.009) and denial + resignation (P = 0.036) were significantly smaller among patients with no CP. Also, from pre- to post-transplant, denial (P = 0.049) and denial + resignation (P = 0.044) decreased among patients without a CP, suggesting these patients may have become less oppositional in adjusting to illness. MIA did not correlate significantly with patient survival but survival correlated significantly with CP presence (P = 0.039) and CP frequency > 75% (P = 0.019). MIA correlated significantly with select items on FACT-BMT, POMS, and Brief COPE. Better scores on these scales associated with complimentary MIA and worse scores associated with oppositional MIA. Essential is a support program for patients as well as CPs to improve quality and outcome of the BMT experience.