Distress in Hematopoietic Cell Transplant Survivors: A Thematic Analysis of the Survivorship Experience

Abstract

Problem under investigation: Inadequate evidence exists supporting the use of distress screening tools in the hematopoietic cell transplant survivor (HCTS) population, revealing impaired understanding of the survivorship experience. Objectives: This project aimed to improve clinician understanding of the experience of HCTS as it relates to distress, symptom management, and coping skills that influence overall quality-of-life. Background and Theoretical Framework: HCTS are a unique population with complex needs, which influence overall distress. The way in which HCTS interpret distress was approached through the lens of Lazarus and Folkman’s Theory of Stress, Appraisal, and Coping. Project Methods: Thematic content analysis was used to analyze transcribed data gained from semi-structured face-to-face interviews with HCTS in the Blood and Marrow Transplant Center of a comprehensive cancer center. Results: Thematic analysis revealed overarching schemes of distress, coping, and reappraisal. Participants (n=6) identified various areas of distress within physical, psychosocial, and access domains. Problem-focused and emotion-focused coping, and protective factors mitigated distress. Domains undergoing reappraisal after transplant included body, normalcy, meaning of experience, and life view. Potential Significance: Reappraisal as a process of survivorship may offer a mechanism for influencing a survivor’s perception of distress. Positive reappraisal of survivorship experience may contribute to improved quality of life. Implications: This project described unique issues of HCT survivorship experience. Due to limited sample size and qualitative nature of project, it is difficult to justify changes to the current distress screening procedures. However, future research can be directed toward program evaluation of survivorship resources and establishing psychometrics for current screening tools.