The Relationship Between Informational Needs And Psychological Distress With Undergoing Hematopoietic Stem Cell Transplantation

Background:Hematopoietic stem cell transplantation is an effective therapy against hematologic cancer,a group of diseases inducing extremely high mortality and increasingly prevalent in China.In the process of transplantation,patients should have to be incubated in a sterile laminar flow clean cabin without contact with neither their relatives nor other patients for about 6-8 weeks.Such closed environment may result in high prevalence of distress,a common psychological disorder in cancer patients without effective control.Unmet information need has previously been associated with depression and anxiety in some cross-sectional studies.However,the causality between unmet information need and distress has never been studied.Further,the longitudinal patterns of unmet information need and distress during the period within sterile laminar flow clean cabin are unclear in patients undergoing hematopoietic stem cell transplantation.Objectives:We aimed to examine the longitudinal changes in unmet information need and distress within sterile laminar flow clean cabin as well as the causal relationship between unmet information need and distress among patients undergoing hematopoietic stem cell transplantation.Methods:We first performed a semi-structured interview with 10 patients who were undergoing hematopoietic stem cell transplantation in the sterile laminar flow clean cabin.Phenomenological research methods were applied to extract the potential factors that may influence distress.Then we conducted a longitudinal study in 93 patients undergoing hematopoietic stem cell transplantation by repeated measurements of unmet information need and distress at entrance and left of sterile laminar flow clean cabin.Unmet information need was examined by a standard questionnaire.Distress was measured by distress thermometer recommended by NCCN.The temporal relationship between unmet information need and distress was examined by a Poisson linear regression model,adjusting for baseline distress scores,days within cabin,and other potential confounders.Results:1.Results of qualitative researchWe extracted 5 main aspects of factors which may be associated with distress via interviewing with 10 patients undergoing hematopoietic stem cell transplantation.They are:Physical factors: feeling fatigued;nausea and vomiting;sleep disorder.Family and social factors: loneliness;guilty;lack of social role.Environmental factors: isolation environment.Economic factors: medical burden;lack social support.Unmet information need: lack of access to effective information;unperfect evaluation of information.2.Results of longitudinal studyAt entrance of sterile laminar flow clean cabin,mean score of unmet information need was 116.33±33.11 points,which significantly increased to 141.58±44.07 points at left of sterile laminar flow clean cabin(P < 0.0001).Similarly,average degree of distress was 3.89±2.64 points at entrance and increased to 5.80±2.93 points at left of sterile laminar flow clean cabin(P <0.0001).Spearman correlation analysis showed that unmet information need at entrance was significantly correlated with distress(r = 0.206,P = 0.048)at entrance and unmet information need at left(r = 0.535,P < 0.001),whereas distress at entrance was not correlated with distress at left(r = 0.143,P = 0.203).Meanwhile,unmet information need at left was not associated with distress at entrance(? = 0.014,P = 0.365)but distress at left was associated with unmet information need at entrance(? = 0.003,P < 0.001).These results indicated that unmet information need may distress.Therefore,we further examined the prospective and longitudinal associations between unmet information need and distress.The prospective association analysis showed that unmet information need at entrance was significantly associated with distress degrees at left after adjustment for distress scores at entrance and other confounders(? = 0.0036,P = 0.0013).The longitudinal association analysis showed that the change in unmet information need within sterile laminar flow clean cabin was significantly associated with distress at left after adjusting for distress at entrance and other confounders(? = 0.0029,P = 0.0033).Conclusions:The unmet information need and distress are very common and there degrees are higher in patients undergoing hematopoietic stem cell transplantation than other cancer patients.During the period within sterile laminar flow clean cabin,both unmet information need and distress were increasing,indicated that unmet information needs and distress may be ignored in the real-world clinical practice.Unmet information need was prospectively and longitudinally associated with distress in patients undergoing hematopoietic stem cell transplantation.Our results indicated that unmet information needs may be a risk factor for distress in patients undergoing hematopoietic stem cell transplantation.In light of our study,unmet information need might be a candidate target for interventions against distress in patients undergoing hematopoietic stem cell transplantation.However,the effect of strategies reducing unmet information need on distress is warranted for further investigation by clinical trials.