No votes yet
Online Exclusive Article

Importance of Meaning-Making for Patients Undergoing Hematopoietic Stem Cell Transplantation

Katharine E. Adelstein
Joel G. Anderson
Ann Gill Taylor
ONF 2014, 41(2), E172-E184 DOI: 10.1188/14.ONF.E172-E184

Purpose/Objectives: The purpose of this integrative literature review of hematopoietic stem cell transplantation (HSCT) for hematologic malignancies was to determine whether meaning-making might be helpful to improve coping and psychological adaptation as patients navigate HSCT.

Data Sources: CINAHL®, MEDLINE®, and PsychINFO databases, and ancestry searches. Search terms included bone marrow transplant, hematopoietic stem cell transplant, hematologic malignancy, quality of life, lived experience, psychosocial, psychological, isolation, and social support.

Data Synthesis: Twenty-four research articles published from 1989-2012 were included. Five major themes emerged: (a) lived experience, (b) coping style, (c) quality of life, (d) psychological morbidity, and (e) potential for post-traumatic growth. Meaning-making was a thread that ran through each of the key areas of the HSCT experience.

Conclusions: Physical, psychosocial, and spiritual issues arise during HSCT that are unique among patients diagnosed with cancer. Meaning-making is key to adaptive coping and helps to reduce physical, psychosocial, and spiritual challenges, as well as assists patients in experiencing positive personal growth. Interventions focused on meaning-making should be tested in this population.

Implications for Nursing: Nurses are positioned to develop and deliver meaning-making interventions for patients undergoing HSCT and to assess patient-oriented outcomes.


Albrecht, T.A., & Rosenzweig, M. (2012). Management of cancer-related distress in patients with a hematological malignancy. <i>Journal of Hospice and Palliative Nursing, 14</i>, 462-468. doi:10.1097/NJH.0b013e318268d04e

Andrykowski, M.A., Brady, M.J., Greiner, C.B., Altmaier, E.M., Burish, T.G., Antin, J.H., … Henslee-Downey, P.J. (1995). "Returning to normal" following bone marrow transplantation: Outcomes, expectations and informed consent. <i>Bone Marrow Transplantation, 15</i>, 573-581.

Andrykowski, M.A., Brady, M.J., & Hunt, J.W. (1993). Positive psychosocial adjustment in potential bone marrow transplant recipients: Cancer as a psychosocial transition. <i>Psycho-Oncology, 2</i>, 261-276. doi:10.1002/pon.2960020406

Andrykowski, M.A., Lykins, E., & Floyd, A. (2008). Psychological health in cancer survivors. <i>Seminars in Oncology Nursing, 24</i>, 193-201. doi:10.1016/j.soncn.2008.05.007

Baker, F., Zabora, J., Polland, A., & Wingard, J. (1999). Reintegration after bone marrow transplantation. <i>Cancer Practice, 7</i>, 190-197.

Barrett, A.J., & Battiwalla, M. (2010). Relapse after allogeneic stem cell transplantation. <i>Expert Review of Hematology, 3</i>, 429-441.

Bhatia, S., Francisco, L., Carter, A., Sun, C.L., Baker, K.S., Gurney, J.G., & Weisdorf, D.J. (2007). Late mortality after allogeneic hematopoietic cell transplantation and functional status of long-term survivors: Report from the Bone Marrow Transplant Survivor Study. <i>Blood, 110</i>, 3784-3792. doi:10.1182/blood-2007-03-082933

Carpenter, J.S., Brockopp, D.Y., & Andrykowski, M.A. (1999). Self-transformation as a factor in the self-esteem and well-being of breast cancer survivors. <i>Journal of Advanced Nursing, 29</i>, 1402-1411. doi:10.1046/j.1365-2648.1999.01027.x

Collins, C., Upright, C., & Aleksich, J. (1989). Reverse isolation: What patients perceive. <i>Oncology Nursing Forum, 16</i>, 675-679.

Coolbrandt, A., & Grypdonck, M.H. (2010). Keeping courage during stem cell transplantation: A qualitative research. <i>European Journal of Oncology Nursing, 14</i>, 218-223. doi:10.1016/j.ejon.2010.01.001

de Carvalho, E.C., Goncalves, P.G., Bontempo, A.P., & Soler, V.M. (2000). Interpersonal needs expressed by patients during bone marrow transplantation. <i>Cancer Nursing, 23</i>, 462-467. doi:10.1097/00002820-200012000-00009

Farsi, Z., Nayeri, N.D., & Negarandeh, R. (2012). The coping process in adults with acute leukemia undergoing hematopoietic stem cell transplantation. <i>Journal of Nursing Research, 20</i>(2), 99-109. doi:10.1097/jnr.0b013e318257b5e0

Ferrell, B., Grant, M., Schmidt, G.M., Rhiner, M., Whitehead, C., Fonbuena, P., & Forman, S.J. (1992). The meaning of quality of life for bone marrow transplant survivors: Part 1. The impact of bone marrow transplant on quality of life. <i>Cancer Nursing, 15</i>, 153-160. doi:10.1097/00002820-199206000-00001

Gaskill, D., Henderson, A., & Fraser, M. (1997). Exploring the everyday world of the patient in isolation. <i>Oncology Nursing Forum, 24</i>, 695-700.

Heiney, S.P. (1995). The healing power of story. <i>Oncology Nursing Forum, 22</i>, 899-904.

Ho, S.M.Y., Horne, D.J. de L., & Szer, J. (2002). The adaptation of patients during the hospitalization period of bone marrow transplantation. <i>Journal of Clinical Psychology in Medical Settings, 9</i>, 167-175. doi:10.1023/A:1014948211605

Hubbard, G., & Forbat, L. (2012). Cancer as biographical disruption: Constructions of living with cancer. <i>Supportive Care in Cancer, 20</i>, 2033-2040. doi:10.1007/s00520-011-1311-9

Jenks Kettmann, J.D., & Altmeier, E.M. (2008). Social support and depression among bone marrow transplant patients. <i>Journal of Health Psychology, 13</i>(1), 39-46. doi:10.1177/1359105307084310

Johnson-Vickberg, S.M., Duhamel, K.N., Smith, M.Y., Manne, S.L., Winkel, G., Papadopoulos, E.B., & Redd, W.H. (2001). Global meaning and psychological adjustment among survivors of bone marrow transplant. <i>Psycho-Oncology, 10</i>, 29-39.

Lin, H.R., & Bauer-Wu, S.M. (2003). Psycho-spiritual well-being in patients with advanced cancer: An integrative review of the literature. <i>Journal of Advanced Nursing, 44</i>(1), 69-80. doi:10.1046/j.1365-2648.2003.02768.x

Loberiza, F.R., Jr., Rizzo, J.D., Bredeson, C.N., Antin, J.H., Horowitz, M.M., Weeks, J.C., & Lee, S.J. (2002). Association of depressive syndrome and early deaths among patients after stem-cell transplantation for malignant diseases. <i>Journal of Clinical Oncology, 20</i>, 2118-2126. doi:10.1200/JCO.2002.08.757

Mishel, M.H. (1988). Uncertainty in illness. <i>Image: Journal of Nursing Scholarship, 20</i>, 225-232. doi:10.1111/j.1547-5069.1988.tb00082.x

Mohty, B., & Mohty, M. (2011). Long-term complications and side effects after allogeneic hematopoietic stem cell transplantation: An update. <i>Blood Cancer Journal, 1</i>, e16. doi:10.1038/bcj.2011.14

Molassiotis, A., & Morris, P.J. (1998). The meaning of quality of life and the effects of unrelated donor bone marrow transplants for chronic myeloid leukemia in adult long-term survivors. <i>Cancer Nursing, 21</i>, 205-211. doi:10.1097/00002820-199806000-00008

Molassiotis, A., Van Den Akker, O.B.A., Milligan, D.W., Goldman, J.M., & Boughton, B.J. (1996). Psychological adaptation and symptom distress in bone marrow transplant recipients. <i>Psycho-Oncology, 5</i>, 9-22. doi:10.1002/(SICI)1099-1611(199603)5:1<9::AID-PON198>3.0.CO;2-4

Mosher, C.E., Redd, W.H., Rini, C.M., Burkhalter, J.E., & DuHamel, K.N. (2009). Physical, psychological, and social sequelae following hematopoietic stem cell transplantation: A review of the literature. <i>Psycho-Oncology, 18</i>, 113-127. doi:10.1002/pon.1399

Park, C.L., & Folkman, S. (1997). Meaning in the context of stress and coping. <i>Review of General Psychology, 1</i>(2), 115-144. doi:10.1037/1089-2680.1.2.115

Pennebaker, J.W. (2000). Telling stories: The health benefits of narrative. <i>Literature and Medicine, 19</i>(1), 3-18. doi:10.1353/lm.2000.0011

Perry, D. (2000). Psychological and social preparation for bone marrow transplantation. <i>Social Work in Health Care, 30</i>(4), 71-92. doi:10.1300/J010v30n04_05

Persson, L., & Hallberg, I.R. (1995). Acute leukaemia and malignant lymphoma patients' experiences of disease, treatment and nursing care during the active treatment phase: An explorative study. <i>European Journal of Cancer Care, 4</i>, 133-142. doi:10.1111/j.1365-2354.1995.tb00071.x

Persson, L., & Hallberg, I.R. (2004). Lived experience of survivors of leukemia or malignant lymphoma. <i>Cancer Nursing, 27</i>, 303-313. doi:10.1097/00002820-200407000-00007

Polkinghorne, D.E. (1996). Transformative narratives: From victimic to agentic life plots. <i>American Journal of Occupational Therapy, 50</i>, 299-305. doi:10.5014/ajot.50.4.299

Potter, M., & Kerridge, I. (2004). Bone marrow and stem cell transplantation. <i>Medicine, 32</i>(6), 46-49. doi:10.1383/medc.

Pulte, D., Gondos, A., & Brenner, H. (2009). Trends in survival after diagnosis with hematologic malignancy in adolescence and young adulthood in the United States, 1981-2005. <i>Cancer, 115</i>, 4973-4979. doi:10.1002/cncr.24548

Sakalys, J.A. (2003). Restoring the patient's voice: The therapeutics of illness narratives. <i>Journal of Holistic Nursing, 21</i>, 228-241. doi:10.1177/0898010103256204

Sandelowski, M. (1994). We are the stories we tell: Narrative knowing in nursing practice. <i>Journal of Holistic Nursing, 12</i>(1), 23-33. doi:10.1177/089801019401200105

Schoulte, J.C., Lohnberg, J.A., Tallman, B., & Altmaier, E. (2011). Influence of coping style on symptom interference among adult recipients of hematopoietic stem cell transplant. <i>Oncology Nursing Forum, 38</i>, 582-586. doi:10.1188/11.ONF.582-586

Sheldon, L.K., Kazmi, M., Klein, C., & Berry, D.L. (2013). Concerns of stem cell transplant patients during routine ambulatory assessment. <i>Patient Preference and Adherence, 7</i>, 15-20. doi:10.2147/PPA.S38567

Sherman, R.S., Cooke, E., & Grant, M. (2005). Dialogue among survivors of hematopoietic cell transplantation: Support-group themes. <i>Journal of Psychosocial Oncology, 23</i>(1), 1-24. doi:10.1300/J077v23n01_01

Shuster, G.F., Steeves, R.H., Onega, L., & Richardson, B. (1996). Coping patterns among bone marrow transplant patients: A hermeneutical inquiry. <i>Cancer Nursing, 19</i>, 290-297. doi:10.1097/00002820-199608000-00005

Smith, M.C. (2002). Health, healing, and the myth of the hero journey. <i>Advances in Nursing Science, 24</i>(4), 1-13. doi:10.1097/00012272-200206000-00006

Tallman, B., Shaw, K., Schultz, J., & Altmaier, E. (2010). Well-being and post-traumatic growth in unrelated donor marrow transplant survivors: A nine-year longitudinal study. <i>Rehabilitation Psychology, 55</i>, 204-210. doi:10.1037/a0019541

Thain, C.W., & Gibbon, B. (1996). An exploratory study of recipients' perceptions of bone marrow transplantation. <i>Journal of Advanced Nursing, 23</i>, 528-535. doi:10.1111/j.1365-2648.1996.tb00015.x

Volker, T., Hertenstein, B., Arnold, R., Bunjes, D., Denzinger, R., & Kaechele, H. (2001). Associations between coping and survival time of adult leukemia patients receiving allogeneic bone marrow transplantation: Results of a prospective study. <i>Journal of Psychosomatic Research, 50</i>, 277-285.

Watson, S. (2007). An extraordinary moment: The healing power of stories. <i>Canadian Family Physician, 53</i>, 1283-1287.

Whitford, H.S., & Olver, I.N. (2012). The multidimensionality of spiritual wellbeing: Peace, meaning, and faith and their association with quality of life and coping in oncology. <i>Psycho-Oncology, 21</i>, 602-610. doi:10.1002/pon.1937

Widows, M.R., Jacobsen, P.B., Booth-Jones, M., & Fields, K.K. (2005). Predictors of posttraumatic growth following bone marrow transplantation for cancer. <i>Health Psychology, 24</i>, 266-273. doi:10.1037/0278-6133.24.3.266

Widows, M.R., Jacobsen, P.B., & Fields, K.K. (2000). Relation of psychological vulnerability factors to posttraumatic stress disorder symptomatology in bone marrow transplant recipients. <i>Psychosomatic Medicine, 62</i>, 873-882.

Wingard, J.R., Majhail, N.S., Brazauskas, R., Wang, Z., Sobocinski, K.A., Jacobsohn, D., … Socier, G. (2011). Long-term survival and late deaths after allogeneic hematopoietic cell transplantation. <i>Journal of Clinical Oncology, 29</i>(16), 2230-2239. doi:10.1200/JCO.2010.33.7212

Xuereb, M.C., & Dunlop, R. (2003). The experience of leukaemia and bone marrow transplant: Searching for meaning and agency. <i>Psycho-Oncology, 12</i>, 397-409. doi:10.1002/pon.648

Zittoun, R., Achard, S., & Ruszniewski, M. (1999). Assessment of quality of life during intensive chemotherapy or bone marrow transplantation. <i>Psycho-Oncology, 8</i>, 64-73. doi:10.1002/(SICI)1099-1611(199901/02)8:1<64::AID-PON337>3.0.CO;2-R