ISOLA15: A multicenter study to assess the perception of protective isolation in cancer patients receiving hematopoietic stem cell transplantation

Haematopoietic stem cell transplantation (HCST) patients become immunosuppressed after chemotherapy. In order to control the infection risk, they usually receive hospital care in protective isolation until neutrophil recovery. This means for the patient staying alone in a germ-free room with positive pressure and having limited contact with the outside world and with loved ones. However, isolation-related loneliness might increase patient suffering. Thus, the aim of this study was to develop and psychometrically test a self-report questionnaire to assess the patient’s perception of protective isolation.

We developed 28 items according to three dimensions emerged in a metasynthesis: Suffering, Relating to oneself, and Missing the relationship with others. Item selection was performed through focus group, comparison with the findings of two phenomenological studies, and content validity with 22 experts. A total of 17 items yielded an adequate content validity index (CVI). The CVI of the questionnaire was 0.88. Cognitive interviews with 5 patients were used to verify face validity. A validation study was conducted in 10 Italian centres. Participants included 123 adult patients receiving autologous (55%) or allogeneic (45%) HSCT in protective isolation. Patients completed the questionnaires between 7 and 9 days post-transplant. Dimensionality was tested through Exploratory factor analysis (EFA).

The scale yielded adequate psychometric properties, with the exception of 3 items, which were eliminated. The EFA yielded a three-factor solution explaining 49% of the variance. The more patients felt supported by nurses, the less they suffered because of isolation, as they were more able to relate to themselves in a positive way (Table 1).

 Nurses can help patients live their isolation with greater serenity and mitigate their suffering. Risk factors for a negative isolation experience should be taken into account in order to avoid unnecessary patient suffering. Future studies should test the psychometric properties of the questionnaire through confirmatory factor analysis and verify its trans-cultural validity.