Defining and measuring unintended pregnancy: issues and concerns

PURPOSE: The authors describe a proactive model of psychosocial care for patients undergoing blood or marrow transplantation and their families. DESCRIPTION OF PROGRAM: This program for blood or marrow transplantation patients, developed at the Center for Cancer Treatment and Research, Richland Memorial Hospital, and the University of South Carolina School of Medicine in Columbia, South Carolina, involves pretransplant comprehensive psychosocial assessment; development and implementation of an individual psychosocial treatment plan; monitoring and medical management of neuropsychiatric problems; and psychotherapeutic sessions with a psychiatrist. These functions are achieved through the use of a multidisciplinary psychosocial team and ongoing consultation-liaison with the entire blood or marrow transplantation team. CLINICAL IMPLICATIONS: This positive, proactive model demonstrates significant benefit to patients, families, and the blood or marrow transplantation healthcare team. Benefits of this model are derived from psychosocial assessment during work-up, subsequent planning, and communication with the entire team, thus allowing early identification of problems and avoiding escalation and the likelihood of negative outcomes. Less energy is exerted and less resources expended when problems are resolved with early intervention rather than with intensive interventions during transplant. The psychosocial staff members develop strong relationships with patients and families before transplant, increasing the power of interventions and receptivity of the patient. The blood or marrow transplantation team benefits from the ongoing presence of psychosocial staff and the consistency of approaches offered by team members. An integral part of this approach is teaching psychosocial care to all staff members and modeling approaches to problems. Other blood or marrow transplantation centers and centers providing other intensive anticancer therapies may benefit by adapting this model into the day-to-day care of their patients.