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The Meaning of Self-efficacy for Symptom Management in the Acute Phase of Hematopoietic Stem Cell Transplantation

White, Lynn L., PhD, RN, ACNS-BC; Cohen, Marlene Z., PhD, RN, FAAN; Berger, Ann M., APRN, PhD, AOCNS, FAAN; Kupzyk, Kevin A., PhD; Bierman, Philip J., MD

doi: 10.1097/NCC.0000000000000685
Article: PDF Only

Background Hematopoietic stem cell transplantation (HSCT) is an intensive treatment that offers the potential for longer life or cure for some types of cancer. Hematopoietic stem cell transplant is associated with decreased quality of life and functional status and distressing symptoms. Self-efficacy for symptom management (SESM) is a person's belief in his/her ability to implement behaviors to manage these symptoms. Presence of SESM can affect symptom distress, healthcare utilization, and posttransplantation outcomes.

Objective The aim of this study was to explore the meaning of SESM in adults during the acute phase of HSCT.

Methods Interviews were conducted before and at 30 days after transplantation. Descriptive thematic analysis was performed on verbatim interview transcripts.

Results Themes of confidence, being responsible, and caring for mind, body, and spirit were identified, with subthemes of self-confidence, confidence in others, confidence and symptom level, vigilance, self-advocacy, and normalcy. Participants reported having high SESM before transplantation and having much less or no SESM when symptom distress was the most severe.

Conclusions This is the first study to examine the patient's perspective of self-efficacy in the acute phase of HSCT. This contributes to existing literature on the concept of symptom management and expands nursing knowledge of SESM in patients undergoing HSCT.

Implications for Practice Nurses can assess SESM before transplantation and implement interventions to enhance SESM when symptoms are at their most distressing after HSCT. The findings from this study can provide the basis for creating behavioral interventions to enhance self-efficacy for symptom management in HSCT patients.

Author Affiliations: College of Nursing, University of Nebraska Medical Center, Omaha (Drs White, Cohen, Berger, and Kupzyk); Avera McKennan Hospital and University Health Center, Sioux Falls, South Dakota (Dr White); Department of Nursing, Augustana University, Sioux Falls, South Dakota (Dr White); Department of Internal Medicine, Division of Oncology & Hematology, College of Medicine, University of Nebraska Medical Center, Omaha Nebraska (Dr Bierman).

Dr White has been supported by scholarships from the Jonas Nurse Leader Program and Oncology Nursing Society. These funding sources were not involved in the research or preparation of the article for publication.

The authors have no conflicts of interest to disclose.

Correspondence: Lynn L. White, PhD, RN, ACNS-BC, Augustana University, 2001 S Summit Ave. Sioux Falls, SD 57197 (

Accepted for publication October 11, 2018.

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