When Relationship-Based Care Is Not an Option

A 26-year-old male with acute myeloid eukemia is admitted for treatment of refractory disease. He begins treatment with blinatumomab (Blincyto) continuous infusion for 28 days with the option for discharge on day 9, pending symptom management and treatment response. The patient’s only support is his 24-year-old significant other, given his family is working and lives in Las Vegas, Nevada. On day 2, of treatment executive leadership mandates all visitors must cease given the spread of the coronovirus.

A 72-year-old male is scheduled to be admitted for stem cell transplantation for non-Hodgkin’s lymphoma with his darling wife of 50 years. His wife has never left his side for the past years and has been a significant partner in his successful treatments. The patient has only agreed to undergo transplant knowing his wife will be present each step of the way. On the day prior to admission, the bone marrow transplant coordinator informs the couple she will be unable to stay to minimize the spread of coronovirus.

What do you respond when the patient says the following?

“But I have no family nearby and she is my motivation.”

“We’ve never been apart longer than 2 days.”

“But my situation is different. Can’t you make an exception?”

“Doesn’t the hospital realize cancer patients need their family by their side?”

“How long is this decision going to be instituted?”

According to Klompas in 2020, in the midst of the Coronavirus disease we must “bolster our approach to routine respiratory viruses.”¹ Historically, respiratory viruses were managed passively. Signs were placed on the door to alert everyone entering the room of the appropriate personal protective equipment to wear. Inconsistent practices were instituted to ensure compliance depending on the department and peer accountability. Masks, alone, were considered enough protection, while providers often forgot that viruses could also be transmitted through feces, eye contact, and the oral cavity. Healthcare workers would come to work sick and not be sent home by unit leadership. Many would be unpaid if they were sent home if they had already exhausted their paid time off.

Given our current climate, we must be intentional with our approach, starting within the admission department through the journey of the patient to the outpatient setting. If each patient throughout an acute care setting has family at the bedside, the modes of transmission are exemplified tremendously. Respiratory viruses infect “10% of the population each year and causes tens of thousands of deaths in the United States each year,” according to a 2018 study.² It is therefore our responsibility as healthcare workers to ensure the safety of our patients and do what is in their best interest. Although this approach is may not be favorable in the eyes of our cancer patients, they will thank us later for keeping them SAFE.

References:

• Klompas, M. (2020). Coronovirus disease 2019 (COVID-19): Protecting hospitals from the visible. Annals of Internal Medicine, 1-3. Doi:10.7326/M20-075

• Rolfes, MA., Foppa, IM., Garg, S., Flannery, B., Singleton, J., Burns, E., Jernigan, D., Olsen, S., Bresee, J., Reed, C. (2018). Annual estimates of the burden of seasonal influenza in the United States: a tool for strengthening influenza surveillance and preparedness. Influenza Other Respiratory Viruses, 12, 132-137. Doi: 10.1111/irv.12486.