Working together for children with cancer

December 12, 2006
Home Visits: New pediatric oncology program helps families adjust

Nurse Kendal Temple conducts home visits to pediatric patients as part of a new service sponsored by DFCI and Children's Hospital Boston. (Sam Ogden photo)

Nurse Kendal Temple conducts home visits to pediatric patients as part of a new service sponsored by DFCI and Children's Hospital Boston.
(Sam Ogden photo)

No strangers to firsts, Children's Hospital Boston and Dana-Farber are again making waves in pediatric oncology with their new Home Visits service. One of several services from the Oncology Community Outreach Program available through Dana-Farber/ Children's Hospital Cancer Care (DF/CHCC), this patient/family education service helps newly diagnosed pediatric oncology patients and their families adjust to living with cancer.

The Oncology Community Outreach Program encompasses several transitional services, such as the Back to School and Call Back programs, which help bridge the gap between hospital and home by providing personalized educational support to families touched by childhood cancer.What makes Home Visits unique is that it focuses exclusively on the needs of newly diagnosed families; a DF/CHCC employee travels to the patient's home and meets with the homecare nurse to develop a care plan.

Kendal Temple, RN, an Oncology Community Outreach nurse who since 1999 has worked on 6 West – the Children's hematopoietic stem cell transplantation unit – is the full-time nurse assigned to coordinate and conduct home visits. Her supervisor, Kathy Houlahan, MS, RN, nurse manager for the hematology/ oncology/stem cell transplant program, drove the grant submission process and secured funding through Dana-Farber for this service.

"In my 23 years at Children's, I've seen hundreds of families wrestle with conflicting emotions when they first leave the hospital," says Houlahan. "While families feel excited and relieved to be returning home, the minute they walk outside, they also feel overwhelmed by the idea of assuming primary care duties for their child. This can be very scary, and it is our hope that home visits will provide the support these patients and families need as they transition back into the community."

Collaborative care

The program guarantees interested newly diagnosed families an in-home visit within 24-48 hours of their first inpatient discharge from Children's. Spending time in the family's home and providing education to the patients, families, and homecare nurses helps all adjust to, and become comfortable with, managing medical duties. It also gives Temple a chance to connect with the child's homecare nurse.

"Whenever possible, I plan my visit to coincide with a visit from their homecare nurse," Temple says. "By meeting with the homecare nurse and the family at the same time, both learn more about the patient's type of cancer, potential side effects of treatment, and indications of complication. In the end, we expect this will lead to improved homecare outcomes and increased patient satisfaction levels."

All of Temple's current patients have acute lymphoblastic leukemia (ALL) and live within 90 minutes of Greater Boston. Not only is ALL the most common type of childhood cancer, but patients with ALL are also at higher risk than children with other forms of cancer for developing treatment-related complications.

Houlahan and Temple expect the educational aspect of Home Visits to improve communication between the home and hospital care teams, ensuring that patients return to the hospital for advanced care at the earliest suggestion of a complication. As the program grows, they'll offer it to all newly diagnosed patients with cancer, as well as stem-cell transplant and end-of-life patients.

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