Eina Nishioka

Objective: This study aimed to elucidate the transition process of young adult cancer survivors who underwent allogeneic hematopoietic stem cell transplantation and were subsequently followed-up with as outpatients after discharge. Method: The study involved five participants, aged between 20 to 40, who underwent allogeneic hematopoietic stem cell transplantation in their 20s and were followed-up with long-term after discharge. Semi-structured interviews were conducted, and the data were analyzed qualitatively and inductively, using the conceptual framework of transitions theory. Results: The type of transition process experienced by young adult cancer survivors following allogeneic hematopoietic stem cell transplantation was a health/disease transition. Transplantation initiated changes that led to multiple, sequential transitions, which were interrelated down to the response pattern. The characteristics of young adult survivors who underwent transplantation were marked by “progressing toward their goals” while simultaneously “dealing with new life events” and “feeling conflicted about not being able to live the life they had envisioned”. Psychologically, there were conflicting meanings of “acceptance of the positive aspects of the transplant experience” and “acceptance of the negative aspects of the transplant experience”, and the participants evidently struggled to regulate their psychological state. Discussion: The transition process for young adult cancer survivors who have undergone transplantation involves a struggle to achieve engagement and progress toward mastery. Therefore, it is essential for care providers to support survivors throughout the entire transition process.

OBJECTIVES: This study was performed to examine the content of decision-making support and patient responses, as documented in the nursing records of individuals with cancer. These patients had received outpatient treatment at hospitals that met government requirements for providing specialized cancer care. METHODS: Nursing records from the electronic medical record system (in the subjective, objective, assessment, and plan [SOAP] format), along with data from interviews, were extracted for patients receiving outpatient care at the Department of Internal Medicine and Palliative Care and the Department of Breast Oncology. Data analysis involved simple tabulation and text mining, utilizing KH Coder version 3.beta.07d. RESULTS: The study included 42 patients from palliative care internal medicine and 60 from breast oncology, with mean ages of 70.5 ± 12.2 and 55.8 ± 12.2 years, respectively. Decisions most frequently regarded palliative care unit admission (25 cases) and genetic testing (24 cases). The assessment category covered keywords including (1) "pain," "treatment," "future," "recuperation," and "home," as terms related to palliative care and internal medicine, as well as (2) "treatment," "relief," and "genetics" as terms related to breast oncology. The plan category incorporated keywords such as (1) "treatment," "relaxation," and "visit" and (2) "explanation," "confirmation," and "conveyance." CONCLUSIONS: Nurses appear crucial in evaluating patients' symptoms and treatment paths during the decision-making support process, helping them make informed choices about future treatments, care settings, and genetic testing. However, when patients cannot make a decision solely based on the information provided, clinicians must address complex psychological concepts such as disease progression and the potential genetic impact on their children. Further detailed observational studies of nurses' responses to patients' psychological reactions are warranted.