Bone Marrow Transplantation: The Battle for Hope in the Face of Fear

Purpose/Objectives: To describe patients' experience of having an autologous bone marrow transplantation (BMT).

Design: Hermeneutic phenomenologic, descriptive, and interpretive.

Setting: Outpatient treatment area of a comprehensive cancer center in the Southwest.

Sample: 20 adult survivors of autologous BMT, 15 women and 5 men, with a mean age of 46 years.

Methods: Content analysis of verbatim transcriptions of open-ended interviews using hermeneutic phenomenology, which combines descriptive and interpretive phenomenology.

Conclusions: These patients illustrate that fear, a predominant reality when undergoing autologous BMT, is balanced with hope for survival. The overarching fear, fear of death, often was related to the unknown, including cancer recurrence. The fear of the unknown also came from being unprepared physically and emotionally. Losses were intertwined with these fears and included loss of both control and trust in one's body. Patients discussed fear of leaving the hospital and not having someone 'constantly looking at you to make sure that the cancer isn't back.' These fears and losses changed patients' view of life and led to a need for help in bringing closure to the experience.

Implications for Nursing Practice: Specific nursing actions to help allay fear include providing information about both feelings and procedures, giving opportunities to discuss fears and losses, arranging meetings with others who have had a BMT or suggesting an appropriate support group, and including family in all interventions, as appropriate. Reducing fears with these interventions helped patients maintain hope. By understanding the relationship between hope and fear, nurses caring for people having BMT can use specific strategies to decrease fear, hence increasing hope in patients. Nursing education can emphasize the need to adequately prepare patients. Further research is indicated to explore the effectiveness of interventions to prepare patients for BMT and the interplay between hope and fear.