Daniels Nikki C, Bodd Monica H, Locke Susan C, LeBlanc Thomas W
Duke University, Durham, NC, USA.
Duke University School of Medicine, Durham, NC, 27710, USA.
Support Care Cancer. 2023 Jul 5;31(7):443. doi: 10.1007/s00520-023-07917-x.
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.
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.
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.
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.
积极应对可调节急性髓系白血病（AML）综合姑息治疗的改善结果。我们定性探索了患者的应对机制，以更好地理解这种关系。
我们纳入了因强化化疗入住杜克医院住院血液恶性肿瘤科的高危AML患者。本研究是对先前收集的纵向定性数据的二次分析，访谈于2014年2月至2015年8月期间进行。访谈在NVivo中进行编码，以识别面向问题应对和回避应对的例子。
患者表现出多种形式的面向问题应对，包括接受、积极重新构建、积极应对、宗教应对和社交应对。接受包括接受他们的预后、AML的不确定性以及疾病导致的生活方式改变。患者通过推测情况可能更糟、从经历中获得意义以及对以前视为理所当然的活动表达新的感激之情来进行积极重新构建。社交应对包括患者从社区或护理团队获得支持；然而，一些人因成为家人的“负担”而感到内疚。回避应对包括否认、行为脱离和自责。一些人否认他们的预后，但否认更常见的表现是患者在认知上与疾病保持距离。患者描述的许多行为脱离都归因于他们的症状（即嗜睡），这使患者无法维持人际关系或参与以前喜欢的活动。
这些结果表明，在最近诊断为AML的情况下，应对机制的应用具有多样性和细微差别。未来的研究应在新型低强度AML治疗的背景下研究应对情况。
