Coping patterns among bone marrow transplant patients: a hermeneutical inquiry

Abstract

Bone marrow transplantation (BMT) has recently become the treatment of choice for a number of malignancies. This procedure is highly technical, involving the use of radiation and chemotherapy to destroy the patient's diseased bone marrow and with it functions of the entire immune system. It is a process with toxic effects that are experienced by all patients to varying degrees. A great deal of research related to the physiological aspects of this procedure has already been done, but considerably fewer studies have examined the psychosocial aspects of the BMT procedure from the patient's perspective. Knowledge about how BMT patients understand this process and cope with its effects is important information for nurses taking care of these patients. The purpose of the study was to describe in depth the patterns of meaning employed by patients in the hospital as they coped with the experience of their BMT. Eleven patients were interviewed from one to four times a week throughout their hospitalization. Hermeneutic analysis was used to identify five major themes: physiological functioning, alertness, attitude, social relationships, and spirituality. Implications from the findings for nursing practice are discussed.

Patients' Experiences of Appearance Changes Following Allogeneic Bone Marrow Transplantation

“…The effects of social isolation being both positive and negative is supported by a longitudinal study of BMT patients that found that time away from others was valued, yet at times, social contact was missed greatly. 29 This suggests that clinical judgment is required to determine support needed by patients at various times during treatment, especially as losses in confidence could potentially prevent patients from assertively expressing their need for support or time alone. It therefore could also be helpful to normalize variations in support needs and provide repeated opportunities for patients to indicate whether they are receiving their required level of support.…”

3233 Safe in the bubble, out into the unknown: Returning home following allogeneic stem cell transplantation: A phenomenological study

“…GVHD is a major determinant of the QoL of survivors. Chronic GVHD is most strongly correlated with worse QL after 6 months post transplantation This section reviews a qualitative study of patients undergoing allogeneic and autologous stem cell transplant in hospital (Shuster et al 1996), a personal account of the stem cell transplant experience (Morstyn 2009) and a descriptive longitudinal study (Schulmeister et al (2005) exploring patients' perceptions of QoL, quality of care and patient satisfaction whilst undergoing autologous SCT for a variety of conditions including haematological malignancy on an outpatient basis. The studies are summarised in Table 1.…”

“…The studies are summarised in Table 1. Shuster et al (1996) interviewed patients (n=11) during their hospitalisation for SCT including one who had an autologous and ten who had an allogeneic SCT. Informants were interviewed between one and four times a week whilst in hospital and once a week for four weeks post discharge.…”

“…Physiological functioning concerned numerous severe challenges such as pain, nausea, itching, fevers, sweats, chills and seizures along with difficulties in eating and the discomfort of tubes such as intravenous devices. The authors (Shuster et al 1996) identified a thread between all five core themes which led them to describe the 'dialectic of patient coping experience' (Shuster et al 1996 p 5). In essence the informant's vacillated between two poles; a desire for connectedness and a sense of disconnection in order to deal with their experience.…”

“…Several authors endeavour to distinguish strategies used by patients to cope with their diagnosis and ensuing disease trajectory (Cohen & Ley 2000, Bulsara et al 2004, Frick et al 2005, Shuster 1996, Coolbrandt & Grypdonck 2010. Cohen & Ley's (2000) study of twenty adult survivors of autologous stem cell transplant (see Table 2) begins to explore the relationship between hope and fear and the role that nurses can play in preparing and supporting patients throughout their journey.…”