Conceptualizing the psychosocial elements that should be assessed in candidates for hematopoietic cell transplantation: social workers' and psychologists' perspectives.

Abstract

Background: In the United States, approximately 23,000 hematopoietic cell transplantations (HCT), also known as a bone marrow transplant, are performed annually. Patients who undergo HCT are among the most acutely ill and medically vulnerable oncology populations. Given the arduous nature of HCT, patients undergo an extensive pre-transplant evaluation that typically includes psychosocial assessment. The literature lacks a well-defined conceptual framework of the psychosocial elements that should be assessed in HCT candidates. This has led to practice variation, which has in turn inhibited high quality psychosocial research. Method: Social workers and psychologists in HCT were recruited to participate in a concept mapping study to elucidate the conceptual domain of psychosocial elements that should be assessed in candidates pre-HCT. Concept mapping is a mixed methodology that uses quantitative methods (multidimensional scaling and hierarchical cluster analysis) to analyze qualitative data. It results in a series of maps that depict the group’s composite thinking about the conceptual domain. Results: Participants brainstormed 114 distinct psychosocial elements and conceptualized the elements into 12 distinct clusters: Transplant Mindset, Support System, Caregiver, Lodging and Transportation, Financial and Legal, Work, Demographic Characteristics, Mental Health, Communication, Education and Resource Needs, Physical Functioning, and Cognition. Analyses of importance ratings showed that that participants who use standardized psychosocial risk rating scales in their practice did not prioritize these clusters differently than those who do not use risk rating scales in their practice. Conclusion: Findings show that the domain of psychosocial elements is broad and multi-dimensional. The conceptualization converges with the literature in many respects but also contains noteworthy divergences from the current literature. Divergences are of particular interest since the perspectives of these psychosocial professionals have been largely absent from the literature. The maps and findings may be used to inform the development of a pre-HCT psychosocial assessment protocol that would constitute a high quality practice standard and produce consistent data for psychosocial research.