Hepatic veno-occlusive/sinusoidal obstruction syndrome (VOD/SOD) is a serious complication of hematopoietic stem cell transplantation (HSCT) caused by toxicity that results in obstruction of small veins in the liver. It can occur in 10-20% of patients undergoing HSCT, and certain high-risk populations have even higher incidence.
Mortality outcomes have improved over the past few years. However, as many as 30-60% of patients who develop hepatic VOD/SOD will experience severe morbidity including multiorgan dysfunction or failure.
Team-based care is standard for patients undergoing HSCT, but there are different types, or scopes, of clinical team care. Multidisciplinary care can involve surgeons, medical doctors, radiologists, specialists, nurses, palliative care, nutritionists, care coordinators, support staff, and others, though they tend to work as needed and when called upon. Interdisciplinary care can involve the same players, but representation from many different areas will typically attend rounds and contribute to the whole care plan with a focus on synthesis of expertise.
In an article published in the Journal of Pediatric Hematology/Oncology, Kristin Mangada, CFNP, and colleagues at the Dana Farber Cancer Institute in Boston, Massachusetts detailed the composition and inter-/multidisciplinary structure of their VOD/SOD interprofessional team.
The interprofessional team described fell under 2 separate umbrellas: a multidisciplinary component that could change composition as needed, and an interdisciplinary component that served as the core care team. The interdisciplinary component was comprised of physicians, advanced practice providers, pharmacists, nurses, dieticians/nutritionists, and, if the patient was in the ICU, critical care clinicians. These professionals were typically present at daily rounds. The expanded multidisciplinary component included psychosocial providers, pain/symptom management experts, clinical assistants, and radiologists or other specialties as clinically indicated. These professionals were not present in daily care but served on the care team as needed.
Nurses were essential to the interdisciplinary team. Several types of nurses were needed, including bedside nurses, a charge nurse, a nurse practitioner, and a nurse educator. Nurses are charged with the heaviest burden of real-time patient care, including monitoring and administering medications, reporting status changes, developing rapport, making treatment recommendations, monitoring fluid levels, determining level of care, educating families about rationale and expected outcomes, and developing training tools for other staff on the care team.
“The core interdisciplinary HCT team’s composition should center on the needs of the patient and institutional resources and involve the expertise of additional multidisciplinary team members based on clinical need. Prospective, patient-centered and outcomes research in this area may help decrease morbidity and mortality and may improve patient and provider satisfaction,” reported Mangada et al.
The authors also noted that this model of care is not strictly limited to the reported complication, stating that “although the care described is focused on VOD, the concepts apply to the management of other complex posttransplant complications, including, but not limited to, transplant-associated thrombotic microangiopathy, severe acute graft-versus-host disease, and respiratory failure.”
Interprofessional team-based care of the hematopoietic cell transplantation patient with hepatic veno-occlusive disease/sinusoidal obstruction syndrome.