Dyadic predictors of psychosocial distress in patients undergoing autologous hematopoietic stem cell transplant (HSCT).

摘要

Hematopoietic stem cell transplantation (HSCT) is a medically and psychologically taxing procedure for patients and their caregivers. Couples in which one partner is undergoing HSCT are faced with navigating multiple life changes and dyadic psychosocial stressors. Although autologous HSCT is generally lower risk and with fewer complications, autologous HSCT patients experience similar, if not greater, rates of distress, depression, and anxiety than allogeneic HSCT patients. To date, there is limited research on autologous HSCT patients and partnered dyads in HSCT. The primary goal of this longitudinal study was to investigate if unique pre-transplant characteristics of the partnered dyad were predictive of and protective against post-transplant patient psychosocial distress. This study included 48 dyads, mean age 61.69 (SD = 8.65), inclusive of primarily male patients (66.7%), diagnosed with Multiple Myeloma (52.1%), with low disease risk (63.8%), and low psychosocial risk (91.4%). Dyads completed pre-transplant surveys assessing relationship satisfaction (Revised Dyadic Adjustment Scale), quantity of social support (Partner Responses to Cancer Inventory), social support effectiveness (Social Support Effectiveness-Questionnaire) and common dyadic coping (Dyadic Coping Inventory), with patients also answering questions assessing psychological distress (Brief Symptom Inventory-18), transplant-specific distress (Impact of Events Scale-Revised), and depression (Center for Epidemiological Studies Depression Scale). Patients completed a survey approximately one month post-transplant reassessing each measure of psychosocial distress. Using couples as the unit of analysis, results revealed relationship satisfaction was not a significant predictor of post-transplant patient psychosocial distress. Higher caregiver and patient perceived social support effectiveness were significant predictors of lower post-transplant patient depression. Furthermore, patient perception of support effectiveness was predictive of psychological distress and depression above and beyond both caregiver perception of support effectiveness and perceived quantity of time of support provided. Lastly, patients with higher common dyadic coping had lower post-transplant, transplant-specific distress. Clinical implications include informing potential ways to address or prevent psychosocial distress through focused dyadic interventions to enhance perceived support effectiveness and promote common dyadic coping early in treatment. Future research should further examine the interrelatedness between the overarching constructs in this study (relationship satisfaction, social support effectiveness, and common dyadic coping) to more fully understand their associations and impact on HSCT patient psychosocial distress.