Patients' experience before, during and after stem cell transplantation-phenomenological study
Neumann, Joyce Lynn
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Patients with refractory hematological malignancies are frequently candidates for life saving but potentially life threatening treatment such as stem cell transplantation (SCT). The purpose of this study was to develop our understanding of the meaning SCT has for African-American, Latino, and Caucasian patients before, during, and after stem cell treatment. An extensive review of the literature was conducted to establish a board understanding of the topic. In the study a hermeneutic phenomenological method with the philosophical underpinnings of Ricoeur was used to complete analysis of data from interviews that were conducted before treatment began, at the time of blood count recovery, and day 30, 60, and 100 after stem cell transplantation. Three major overlapping themes emerged, based in the experiences of the participants; Facing the Fear occurred before SCT treatment began, Getting Through during active treatment, and Going Beyond, Forward primarily during the time period after SCT (30 to 100 days after treatment). Like a Bridge I Never Crossed Before influenced the meaning experiences had for participants across the 3 themes. Contextual factors of life threatening disease and treatment, lack of experience or knowledge, emotional/coping, culture, symptom burden, and financial burden influenced the transition between the phases of SCT. Additional subthemes which enhanced their experience were identified as Hope for Chances, Choices, and Control; In God's Hands; I Couldn't Have Done This Without Them; Wanting to Know, Not Wanting to Know; and They Went the Extra Mile. These findings provide guidance for caring for SCT patients and their families and they provide direction of ongoing research. Of the implications for care, most convincing is the need for patient-centered care based in an understanding of the contextual factors that affect patient and family coping. Of the implications for research, perhaps most compelling is the need for research related to education to ensure informed consent and preparation for treatment related experiences, in accord with patient needs.