Uncertainty During Autologous Peripheral Blood Stem Cell Transplant: a Grounded Theory Approach

Ashley Singh

doi:10.7273/000005385

Background: Uncertainty throughout treatment is a significant concern for adults diagnosed with cancer due to the disease’s unpredictability. Cancer studies exploring uncertainty have shown a high occurrence of adverse physical and psychological effects. Uncertainty in illness has not been fully explored with the autologous peripheral blood stem cell transplant (PBSCT) population, where reoccurrence and disease progression frequently occur, and survival is not guaranteed.Purpose: The purpose of this study was to explore the process of uncertainty using grounded theory methodology before, during, and after autologous peripheral blood stem cell transplant with the intent to (a) describe the socio-bio demographic, disease, and treatment characteristics of adult autologous peripheral blood stem cell transplant recipients, (b) discover and describe the factors of uncertainty that impact adult autologous PBSCT recipients, (c) explain how these factors affect how adult autologous PBSCT recipients live with uncertainty. Method: Interviews using the grounded theory approach were conducted to answer the research question: How do autologous PBSCT survivors manage uncertainty before, during, and after transplant? Ten participants underwent a single interview during a 20-day window (days 20-40) corresponding to the exit day appointment. Interviews were conducted in person following COVID-19 distancing guidelines. Results: Participants described three stages of uncertainty during the autologous PBSCT: “Monkey on my Shoulders” as uncertainty during a cancer diagnosis, represents the weight of a cancer diagnosis, survival, and progression experienced by the participants; Surviving Uncertainty of the Autologous PBSCT describes the uncertainty of the ability to survive the complications of transplant and the support needed to recover from the transplant; and the final stage demonstrates the recovery period of transplant as Adding a New Identity through Uncertainty (cancer survivor), where participants accept their fate and find new joy in their lives. All three of these stages describe the process of Transitioning to a New Identity through the Uncertainty of Autologous Peripheral Blood Stem Cell Transplant (PBSCT) was found to play a significant role in how patients undergoing autologous PBSCT managed and coped with uncertainty. Conclusion: The grounded theory of Transitioning to a New Identity through the Uncertainty of Autologous Peripheral Blood Stem Cell Transplant (PBSCT) answers the question of how autologous PBSCT recipients experience uncertainty from diagnosis through the autologous PBSCT process. This study demonstrates the complexity and informs understanding of the process in that this patient population manages uncertainty before, during, and after autologous PBSCT. How patients and caregivers cope with uncertainty during these stages adds to understanding how nurses can assess and intervene to decrease uncertainty during autologous PBSCT.

Uncertainty During Autologous Peripheral Blood Stem Cell Transplant: a Grounded Theory Approach

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