Abstract

Purpose：Reduced-intensity stem cell transplantation （RIST） has become a standard treatment for hematological malignancies in patients aged ≥60 years. However, RIST in the elderly is associated with high morbidity and mortality rates. The purpose of this study was to identify the process of meaning of RIST in the elderly.

Methods：Each participant submitted informed consent to participate in this study. All participants were aged ≥60 years, were diagnosed with acute myeloid leukemia or myelodysplastic syndrome, and received RIST at a university hospital. Semi-structured interviews were conducted to assess the process of acceptance of hematopoietic malignancies suffered by the participants. Descriptions were analyzed using a modified grounded theory approach.

Results：This study comprised 10 participants （9 males and 1 female）, aged 60‒70 years. The process of meaning of RIST for the elderly was classified into three core categories：（1） stress associated with a diagnosis of a hematopoietic malignancy and severe adverse events following RIST, （2） wisdom and vigor through life experiences, and （3） expectations of improved quality of life.

Conclusions：The search for meaning of RIST faced by the elderly who received RIST enabled them to overcome severe physical and mental distress associated with hematopoietic malignancies. Furthermore, in the surviving participants, wisdom, vigor, and life experiences were identified to be the most relevant attributes in the face of a life-threatening disease, which the elderly participants credited to their adaptation ability and personal strength acquired from life experiences. It is necessary to offer individualized nursing care based on the three described core processes to enable elderly RIST survivors to share their experiences and provide encouragement to support long-term survival. Furthermore, it is important to provide care for the elderly to achieve spiritual and emotional growth.

Abstract

The objective of this study was to describe the experiences of pancreatic cancer patients who cannot look forward to recovery or long-term survival. A verbatim record was made of interviews carried out with two patients. The characteristics of the patients’ experiences were analyzed and interpreted based on the phenomenological approaches in philosophical anthropology advocated by P. Benner.

The narratives of the two pancreatic cancer patients were described as：“being ready to face reoccurrence and to remain alive while seeking successful treatment”, and “to look for a way to face reality when death looms closer”, indicating that the patients were aware that they had a bad prognosis with a high likelihood of recurrence and death. They understood the significance of their bad prognosis and the likelihood of death through their interactions with medical practitioners. They were expected to understand and accept the risk of recurrence of cancer and the limits to medical treatment. It appeared that on their part they were struggling to prepare psychologically for the future. It was concluded that awareness of passing time affected both their present state of living with their end in sight and their efforts to reject the common perception that pancreatic cancer is a death sentence. These results suggest that support theory should be designed to soften the subconscious impact of the ‘refractory’ in relation to pancreatic cancer, which undermines patient motivation to look to the future, and to tackle the differences in physicians’ and patients’ perceptions of temporality.