Title Valentina Biagioli Tutors PhD in Nursing -XXIX Department of Biomedicine and Prevention DEVELOPMENT OF A SCALE TO ASSESS THE PERCEPTION OF PROTECTIVE ISOLATION IN PATIENTS HOSPITALISED FOR STEM CELL TRANSPLANTATION Title PhD student - 3° year: Valentina Biagioli Michela Piredda, PhD, RN, Assistant Professor Rosaria Alvaro, MSN, RN, Associate Professor Maria Grazia De Marinis, MSN, MEd, RN, Professor Tutors

Background Valentina Biagioli Patients who undergo haematopoietic stem cell transplantation (HSCT) develop therapy-induced neutropenia and are at high risk for severe infections T R A N S P L BONE MARROW C H E M O T R A P Y STEM CELLS AUTOLOGOUS IMMUNOSOPRESSION 1° CAUSE 15 % CONCURREN 35 % ALLOGENEIC INFECTION MORTALITY sibling unrelated ISOLA15

Background PROTECTIVE ISOLATION Valentina Biagioli PROTECTIVE ISOLATION Protective isolation is used as a precautionary measure in several hospitals in Europe Yokoe, D., Casper, C., Dubberke, E., Lee, G., Munoz, P., Palmore, T., et al. (2009). Infection prevention and control in health-care facilities in which hematopoietic cell transplant recipients are treated. Bone Marrow Transplantation, 44(8), 495-507. ISOLA15

Background PROTECTIVE ISOLATION Valentina Biagioli PROTECTIVE ISOLATION «A state in which an individual experiences a reduction in the level of normal sensory and social input with possible involuntary limitations on physical space or movement»

Rationale Valentina Biagioli + Hospitalisation + Loneliness Cancer + The psycho-social implications of protective isolation needs to be investigated further PROTECTIVE ISOLATION Biagioli, V., Piredda, M., Alvaro, R., & De Marinis, M. (2016). The experiences of protective isolation in patients undergoing bone marrow or haematopoietic stem cell transplantation: Systematic review and metasynthesis. European Journal of Cancer Care.   doi: 10.1111/ecc.12461. ISOLA15

Aim of the Study Valentina Biagioli To develop a self-report scale to assess patient’s perception of protective isolation during hospital stay for SCT.

To explore the experience of being isolated in the Italian patients Overview of Methods Valentina Biagioli AIM CONTEXT METHOD in literature Metasynthesis To explore the experience of being isolated QUAL in the Italian patients Phenomenology We conducted 1 meta-synthesis and 2 phenomenological studies about the lived experiences of patients in protective isolation ISOLA15

through a questionnaire Overview of Methods Valentina Biagioli and … We are conducting a multicenter study to validate the self-report questionnaire that we have developed AIM CONTEXT METHOD through a questionnaire Scale Development To measure loneliness QUANT in Italian and UK patients Validation Study ISOLA15

We developed a conceptual model including 3 dimensions: Overview of Methods Valentina Biagioli We developed a conceptual model including 3 dimensions: suffering relating with oneself relating with others We chose the items of the scale based on this model

Overview of Methods Valentina Biagioli The European Guidelines of the Statistical System were used Furr, M. (2011). Scale construction and psychometrics for social and personality psychology. London: SAGE.

SCALE ABOUT THE PERCEPTION OF PROTECTIVE ISOLATION Results SCALE ABOUT THE PERCEPTION OF PROTECTIVE ISOLATION To verify face validity: a focus-group with 10 experts To verify content validity: 22 Experts (11 Italian; 11 English) rated CV for each item 17 items yielded adequate CVI S-CVI was .88 Pre-test in 5 patients I-CVI ≥ .78 S-CVI ≥ .80 Polit, D. F., & Beck, C. T. (2006). The content validity index: are you sure you know what's being reported? Critique and recommendations.  Research in nursing & health, 29(5), 489-497.

SCALE ABOUT THE PERCEPTION OF PROTECTIVE ISOLATION Results SCALE ABOUT THE PERCEPTION OF PROTECTIVE ISOLATION

SUFFERING was expressed with items Results SUFFERING was expressed with items about boredom enhanced fears feelings of being imprisoned movement limitations isolation burden

was expressed with items Results RELATING WITH ONESELF was expressed with items about ability to find meaning safety assuming a new perspective finding the inner strength

was expressed with items Results RELATING WITH OTHERS was expressed with items about missing someone to talk with feeling cut off from the world communication being closed to loved ones

Conclusion A new scale was developed for use in isolated patients undergoing HSCT in hospital The scale yielded a good content validity both in Italian and in English

Practical Implications Nurses should support HSCT patients to find a positive meaning to isolation

Practical Implications Nurses should help patients to search effective defensive strategies in order to perceive themselves as active fighters against cancer and the effects of treatments

Academic Implications A multicentre study is needed: to test the psychometric properties of the scale to compare the level of perceived isolation in relation to the protective measures implemented to identify targeted supportive strategies for isolated patients ISOLA15

Thank you very much for your attention valentina.biagioli@pec.ipasvi.roma.it Biagioli Valentina Piredda Michela Rosaria Alvaro Maria Grazia De Marinis Development of a scale to assess the perception of protective isolation in patients hospitalised for stem cell transplantation