From Surviving to Thriving: Older Adults Adapting and Coping after Hematopoietic Cell Transplant

Topic Significance & Study Purpose/Background/Rationale Due to advances in treatment regimens and supportive care, there are a growing number of older adults with hematologic malignancies undergoing hematopoietic cell transplant (HCT). While these advances have improved overall survival for this population, patients continue to experience rapid decline in physical, emotional, social, and role functioning post-HCT. Nursing interventions can assist with returning to life activities, an important goal for older patients. Current literature on adaptation and coping post-HCT has focused on younger survivors. The purpose of this qualitative descriptive study is to describe the experience of returning to life activities in patients 60 years of age and older who were more than three months post-HCT. Of particular interest was how coping resources and strategies help older patients adapt and cope to limitations in physical, psychological, and cognitive limitations. Methods, Intervention, & Analysis Twenty English speaking adults 60 years and older with hematological malignancy 3 to 12 months post-HCT completed semi-structured interviews. Open-ended questions and probes were guided by the Transactional Model of Stress and Coping to explore adaptive functioning, coping resources, and coping strategies. An integrated grounded theory approach was used to code the textual data to identify themes. Saturation was reached when the interview generated no new substantial information. Findings & Interpretation Eight allogeneic and twelve autologous HCT recipients participated in the interviews. Three main themes emerged from the interviews. Adaptive functioning: all participants described adapting to physical and psychological changes. Coping resources: family (95%) and the healthcare team (80%) helped participants overcome physical, psychological, and cognitive limitations. Coping strategies: participants reported using emotion-focused, problem-focused, and meaning-based coping strategies. Overall, engaging in life activities and social support were significant in the recovery of physical, psychological and cognitive function. Discussion & Implications Older HCT recipients are an understudied population at high risk for functional decline. Patient-centered information on how HCT treatment influences cognitive function, functional outcomes, and quality of life will have broad implications for patient education and development of interventions for HCT patients. The next phase of this study will use these findings to guide development of health promoting interventions that nurses and the healthcare team can implement to help HCT recipients return to life activities.