Graduation Date

Fall 12-15-2017

Document Type

Dissertation

Degree Name

Doctor of Philosophy (PhD)

Programs

Nursing

First Advisor

Marlene Z. Cohen

Abstract

Hematopoietic stem cell transplant (HSCT) is a treatment for hematologic cancers and other hematologic conditions that causes severe treatment-related symptoms. The first 30 days after HSCT, or the acute phase, is when symptoms are most intense. During this time, the ability of patients to manage their symptoms, in collaboration with their health care providers, is crucial to reduce the distress caused by the symptoms. Self-efficacy is the person’s confidence in their ability to perform a behavior, such as symptom management. This body of work describes the concept of self-efficacy for symptom management (SESM), presents an integrated literature review on self-efficacy for symptom management in cancer patients, and presents results from research on SESM during the acute phase of HSCT. The purpose of the longitudinal, descriptive study was to determine changes over time and examine the relationships between SESM, symptom distress and physical function. The meaning of SESM from the patient’s perspective pre- and post-HSCT also was explored. The study established that significant changes occur over time in these variables and that a relationship is present between SESM, symptom distress and physical functional status during the acute phase of transplant. Higher SESM was associated with less symptom distress and increased physical function. When symptom distress was highest, patients felt their worst and their self-efficacy was low, which influences how symptoms are managed, and affects outcomes such as functional status, hospital length of stay and overall quality of life. Assessment of SESM early in the treatment process, followed by patient-centered interventions to enhance SESM, will allow patients to manage their symptoms effectively and improve patient outcomes. The information presented here provides a foundation for future research and development of nursing interventions to enhance a person’s SESM during the acute phase of HSCT.

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