In their own words: a qualitative study of coping mechanisms employed by patients with acute myeloid leukemia

• Published in: Supportive care in cancer Vol. 31; no. 7; p. 443
• Main Authors: Daniels, Nikki C., Bodd, Monica H., Locke, Susan C., LeBlanc, Thomas W.
• Format: Journal Article
• Language: English
• Published: Berlin/Heidelberg Springer Berlin Heidelberg 01-07-2023; Springer; Springer Nature B.V
• Subjects: Analysis; Cancer; Cancer therapies; Chemotherapy; Coping; Hospital patients; Interviews; Leukemia; Lifestyles; Medical prognosis; Medicine; Medicine & Public Health; Nursing; Nursing Research; Oncology; Oncology, Experimental; Pain Medicine; Palliative care; Palliative treatment; Prognosis; Qualitative research; Rehabilitation Medicine; Remission (Medicine); United States > US; Oncology; Coping; Hematology; Qualitative study; Acute myeloid leukemia; Cancer
• ISSN: 0941-4355; 1433-7339
• DOI: 10.1007/s00520-023-07917-x

Purpose
Positive coping mediates improved outcomes from integrated palliative care in acute myeloid leukemia (AML). We qualitatively explored patients’ coping mechanisms to better understand this relationship.
Methods
We enrolled patients with high-risk AML admitted to Duke Hospital’s inpatient hematologic malignancy service for intensive chemotherapy. This study is a secondary analysis of previously collected longitudinal qualitative data, with interviews conducted between February 2014 and August 2015. Interviews were coded in NVivo to identify examples of approach-oriented and avoidant coping.
Results
Patients demonstrated approach-oriented coping in many forms including acceptance, positive reframing, active coping, religious coping, and social coping. Acceptance included accepting their prognosis, the uncertainty of AML, and lifestyle changes due to the disease. Patients exhibited positive reframing by speculating about how their situation could be worse, deriving meaning from their experience, and expressing newfound appreciation for activities previously taken for granted. Social coping involved patients receiving support from their community or care team; however, some expressed guilt for being a “burden” on family. Avoidant coping included denial, behavioral disengagement, and self-blame. Some denied their prognosis, but denial was more commonly demonstrated via patients cognitively distancing themselves from their disease. Much of the behavioral disengagement described by patients was attributed to their symptoms (i.e., lethargy) which prevented patients from maintaining relationships or participating in activities previously enjoyed.
Conclusion
These results demonstrate the diverse and nuanced applications of coping mechanisms amid a recent AML diagnosis. Future research should examine coping in the context of novel low-intensity AML therapies.