Development of a Nursing Intervention Program to Support Intrinsic Motivation-Based Decision Making by Patients Undergoing Hematopoietic Stem Cell Transplantation

Abstract

Abstract

The present study was undertaken to investigate the decision making process by patients concerning transplantation, and to identify physical, psychological, and social problems in the course from disclosure of disease to transplantation, with the ultimate goal of developing a nursing intervention program to provide support to patients undergoing hematopoietic stem cell transplantation (hereinafter “transplantation”).

Interviews using a semi-structured questionnaire were conducted with 13 patients who had undergone transplantation and given informed consent to participate in the study (age 18-55 years). Their responses were analyzed in terms of the physical stress and pain they had experienced during the period between the explanation about transplantation provided by their attending physician to the time of transplantation.

Views held by patients about transplantation could be classified into four categories: “my life can be saved,” “no other means is available,” “cannot postpone the decision any more,” and “hospital visits will be unnecessary after transplantation.” The way patients interpreted their disease and treatment varied greatly among individuals. Emotional fluctuations seen prior to making the decision to undergo transplantation appeared to reflect two feedback processes: “reconfirming the objective of transplantation” and “reconfirming one’s competency.” During these processes, patients select the option of transplantation proposed by the physician through external motivation and convert it to an individual decision through intrinsic motivation while overcoming emotional fluctuation. Nursing intervention based on Deci’s cognitive evaluation theory will be useful in helping patients who have made their decision about transplantation to continue in a positive attitude toward the time of transplantation.

In supporting patients in making decisions about transplantation, it is essential to help them deal with emotional fluctuations during the decision-making process. Based on these findings, we developed a nursing intervention program designed to support intrinsic motivation-based self-decision, making use of cognitive, emotional, and educational support and paying adequate attention to the patient’s own voice.