SMILe_Towards implementation of an Integrated Model of Care in Long-Term Follow-Up after Allogeneic Hematopoietic SteM Cell TransplantatIon faciLitated by eHealth Technology - An effectiveness-implementation science study

Allogeneic stem cell transplantation (alloSCT) is a curative treatment for patients with a variety of malignant and non-malignant hematological diseases, such as acute leukemia or aplastic anemia.

Over the last two decades, improvements in treatment and supportive care have led to rising numbers of transplants and long-term alloSCT survivors. However, alloSCT survivors have a high risk of early complications or late effects such as infections and graft-versus-host disease (GvHD), as well as psychosocial symptoms such as fatigue, depression or emotional distress. This additionally challenges patient’s self-management or adherence following health behavior recommendations e.g medication adherence. Indeed, initially cured patients frequently turn into chronically ill who can benefit from an integrated model of care, which addresses not only biomedical but also behavioral and psychosocial dimensions in follow-up care.

Additionally, eHealth-facilitation showed promise in improving clinical outcomes in cancer or organ transplant patients. However, successful implementation and sustainability of innovative eHealth -facilitated care models require the combined use of implementation-, behavioral-, and computer science methods.

The overall aim of the SMILe project is the development, implementation and testing of an Integrated Care Model for SteM cell transplantatIon faciLitated by eHealth (SMILe-ICM).

Aims

The overall aim of the SMILe project is the development, implementation, testing and evaluation of an Integrated Care Model for SteM cell transplantatIon faciLitated by eHealth (SMILe-ICM).

To reach the overall aim, we followed the two phases of Development and Implementation (Phase A) as well as the Testing and Evaluation (Phase B) by completing the following sub-aims:

Phase A:

1) To identify the target organizations’ structural characteristics and practice patterns in view of chronic illness management; to assess how self-management and behavioral support is currently being supported; and to assess the technology openness of clinicians and alloSCT patients regarding eHealth use along the eCCM dimensions by performing a contextual analysis. (See publication)

2) To develop/adapt the SMILe-Integrated Care Model (SMILe-ICM) by combining implementation , behavioral and computer science methods and to choose adequate implementation strategies per target setting. (See publication)

Phase B:

To test the SMILe-ICM and to evaluate the implementation of the SMILe-ICM regarding feasibility, acceptability, appropriateness and fidelity and the implementation pathway in the first year post-alloSCT.

Methods

Designing and implementing complex interventions into clinical practice is often limited by a lack of adaptation/adaptability to context-specific conditions; the absence of theoretical frameworks to develop and structure their content or to guide eHealth integration into existing care models; and the failure to embrace a user-centered design approach throughout the development process. To overcome these shortcomings, we combined methods from implementation science, behavioral science and computer science when developing, implementing and testing the SMILe-ICM (see publication).

The SMILe-Integrated Care Model

The ready developed SMILe-ICM consists of two components

1) an Advanced Practice Nurse in the role of a Care Coordinator (CC); and

2) the SMILe technology.

The CC provides 12 face-to-face visits in the 1 post-alloSCT to foster patients self-management and health behavior in terms of symptom evaluation, medication adherence, physical activity, and infection prevention.

The SMILe technology consists of the SMILeApp and SMILeCare. Using the SMILeApp, patients can reinforce self-management information and document and submit key medical, symptom, and behavioral parameters to the transplant center on a daily basis. Using SMILeCare, the CC can view the entered data at the transplant center, respond to changes, and adjust intervention visits.