Perceptions of safety in hospital at home following allogeneic haematopoietic stem cell transplantation: A qualitative study

Sigrid Cecilie Tinglum Skøyeneie; Hilde Skuterud Wik; Geir Erland Tjønnfjord; Lena Fauske; Tobias Gedde-Dahl; Grethe Solvang; Anders Eivind Myhre

doi:10.1016/j.ejon.2025.103044

Perceptions of safety in hospital at home following allogeneic haematopoietic stem cell transplantation: A qualitative study

Eur J Oncol Nurs. 2025 Nov 13:80:103044. doi: 10.1016/j.ejon.2025.103044. Online ahead of print.

Authors

Sigrid Cecilie Tinglum Skøyeneie¹, Hilde Skuterud Wik², Geir Erland Tjønnfjord³, Lena Fauske⁴, Tobias Gedde-Dahl³, Grethe Solvang², Anders Eivind Myhre²

Affiliations

¹ Department of Haematology, Oslo University Hospital, Norway; University of Oslo, Norway. Electronic address: s.c.t.skoyeneie@studmed.uio.no.
² Department of Haematology, Oslo University Hospital, Norway.
³ Department of Haematology, Oslo University Hospital, Norway; University of Oslo, Norway.
⁴ Department of Oncology, Oslo University Hospital, Norway.

PMID: 41325692
DOI: 10.1016/j.ejon.2025.103044

Abstract

Purpose: Hospital at Home (HaH) is an innovative care model designed to provide hospital-equivalent care at home substituting traditional inpatient care. Previous research has demonstrated the clinical safety of HaH, but there is limited qualitative knowledge about the experiences of safety among those who attend. As patients become severely immunocompromised and require close monitoring following allogeneic haematopoietic stem cell transplantation (HSCT), safety perceptions are important. This study aimed to explore how patients and informal caregivers perceived safety in HaH following HSCT.

Methods: A qualitative exploratory design with a phenomenological hermeneutical approach was used. Semi-structured interviews were conducted with 16 patients and 14 informal caregivers. Data were analysed using reflexive thematic analysis.

Results: (1) From ambivalence to attendance. Participants were initially ambivalent. However, comprehensive preparatory information, the option to withdraw, and flexibility to return to hospital at any time were key factors influencing their decision to participate. (2) The organisation and practice shaped the perceptions of safety. Participants perceived HaH as safe due to structured care and consistent follow-up they received. Continuity, competence, and availability of the healthcare team provided reassurance. (3) Prepared for the expected. Participants felt prepared for potential health deterioration and the possibility of readmission, drawing on previous treatment experiences and proactive preparation.

Conclusions: Participants perceived HaH as a safe alternative to inpatient care, emphasising clear organisational structures, preparatory information, and continuous support. Predictability, trust in the professional competence of the care team, and flexible options for readmission were crucial to their sense of safety. These findings underscore the importance of structured follow-up and adequate preparation in the successful implementation of HaH programs. The findings highlight the importance of risk assessment, thorough training and preparation, flexible hybrid care models, and team continuity.

Keywords: Allogeneic haematopoietic stem cell transplantation; Home care services- hospital based; Hospital at home; Patient safety; Qualitative research; Safety.