Balancing risks and rewards: How hematologists discuss uncertainty in allogeneic hematopoietic cell transplantation outcomes.

Autor: Rodenbach RA; University of Wisconsin Carbone Cancer Center, Madison, WI, USA. Electronic address: rachel_rodenbach@urmc.rochester.edu., Thordardottir T; University of Wisconsin Carbone Cancer Center, Madison, WI, USA., Brauer M; University of Wisconsin Department of Psychology, Madison, WI, USA., Hall AC; University of Wisconsin Carbone Cancer Center, Madison, WI, USA., Ward E; University of Wisconsin Carbone Cancer Center, Madison, WI, USA; University of Wisconsin School of Medicine and Public Health, Department of Family Medicine and Community Health, Madison, WI, USA., Smith CB; Icahn School of Medicine at Mount Sinai, New York, NY, USA., Campbell TC; University of Wisconsin Carbone Cancer Center, Madison, WI, USA.
Jazyk: angličtina
Zdroj: Patient education and counseling [Patient Educ Couns] 2024 Jun; Vol. 123, pp. 108177. Date of Electronic Publication: 2024 Feb 01.
DOI: 10.1016/j.pec.2024.108177
Abstrakt: Objective: Allogeneic hematopoietic cell transplant (alloHCT) offers many patients with blood cancers a chance of cure but carries risks. We characterized how hematologists discuss the high-risk, high-reward concept of alloHCT.
Methods: Qualitative analysis of video-recorded virtual encounters of hematologists who routinely perform alloHCT with actors portraying an older man recently diagnosed with high-risk myelodysplastic syndrome.
Results: Hematologists (n = 37) were a median age of 44 years, 65% male, and 68% white. They frequently used "teeter-totter" language that juxtaposed alloHCT's risks and rewards in a dynamic, quickly alternating fashion and communicated uncertainty in transplant outcomes. This dialogue oscillated between encouragement about alloHCT's potential for cure and caution about its risks and occurred within single speech turns and in exchanges between hematologist and patient. Fewer hematologists outlined their big-picture stance on transplant's risks and benefits early in the conversation. Meanwhile, hematologists varied in how they counseled patients to manage transplant-related uncertainty and consider treatment decision making.
Conclusion: Hematologists use "teeter-totter" language to express hope and concern, confidence and uncertainty, and encouragement and caution about the high-risk, high-reward nature of alloHCT.
Practice Implications: Teeter-totter language may help frame big-picture content about alloHCT's risks and benefits that is essential for patient education and decision making.
Competing Interests: Declaration of Competing Interest The authors declare the following financial interests/personal relationships which may be considered as potential competing interests: Rachel Rodenbach reports financial support was provided by National Heart Lung and Blood Institute. Markus Brauer reports financial support was provided by University of Wisconsin-Madison Office of the Vice Chancellor for Research and Graduate Education.
(Copyright © 2024 Elsevier B.V. All rights reserved.)
Databáze: MEDLINE
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