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Perceptions of safety in hospital at home following allogeneic haematopoietic stem cell transplantation: A qualitative study

Year: 2025

Type: article

Abstract: PURPOSE: Hospital at Home (HaH) is an innovative care model designed to provide hospital-equivalent care at home substituting traditional inpatient care. Previous research has demonstrated the clinical safety of HaH, but there is limited qualitative knowledge about the experiences of safety among those who attend. As patients become severely immunocompromised and require close monitoring following allogeneic haematopoietic stem cell transplantation (HSCT), safety perceptions are important. This study aimed to explore how patients and informal caregivers perceived safety in HaH following HSCT. METHODS: A qualitative exploratory design with a phenomenological hermeneutical approach was used. Semi-structured interviews were conducted with 16 patients and 14 informal caregivers. Data were analysed using reflexive thematic analysis. RESULTS: (1) From ambivalence to attendance. Participants were initially ambivalent. However, comprehensive preparatory information, the option to withdraw, and flexibility to return to hospital at any time were key factors influencing their decision to participate. (2) The organisation and practice shaped the perceptions of safety. Participants perceived HaH as safe due to structured care and consistent follow-up they received. Continuity, competence, and availability of the healthcare team provided reassurance. (3) Prepared for the expected. Participants felt prepared for potential health deterioration and the possibility of readmission, drawing on previous treatment experiences and proactive preparation. CONCLUSIONS: Participants perceived HaH as a safe alternative to inpatient care, emphasising clear organisational structures, preparatory information, and continuous support. Predictability, trust in the professional competence of the care team, and flexible options for readmission were crucial to their sense of safety. These findings underscore the importance of structured follow-up and adequate preparation in the successful implementation of HaH programs. The findings highlight the importance of risk assessment, thorough training and preparation, flexible hybrid care models, and team continuity.

Source: European Journal of Oncology Nursing

DOI: 10.1016/j.ejon.2025.103044