Perspectives of patients with multiple myeloma on accepting their prognosis—A qualitative interview study

• Published in: Psycho-oncology (Chichester, England) England), 2021-01, Vol.30 (1), p.59-66
• Main Authors: Hermann, Myriel, Kühne, Franziska, Rohrmoser, Amy, Preisler, Martina, Goerling, Ute, Letsch, Anne
• Format: Article
• Language: English
• Subjects: Acceptance; acceptance process; advance care planning; Advance directives; Barriers; cancer; Content analysis; Coping; Decision making; Interviews; Malignant; Medical prognosis; Mental disorders; Mental health; Multiple myeloma; Myeloma; Oncologists; oncology; palliative care; Physical symptoms; psychological adaptation; Psychological distress; psycho‐oncology; Qualitative research; Social support; Sociodemographics; Symptoms; Uncertainty
• ISSN: 1057-9249; 1099-1611
• DOI: 10.1002/pon.5535

Objective Prognostic awareness is essential for making treatment decisions in malignant diseases. Being confronted with a poor prognosis, however, can affect patients' mental health. Therefore, it is important to study coping in the context of malignant diseases. Acceptance is an adaptive coping strategy associated with less psychological distress. This study sought to explore the facilitators and barriers for prognostic acceptance in a sample in which both hope and uncertainty regarding prognosis are pronounced: multiple myeloma patients. Methods In a German university hospital, 20 multiple myeloma patients participated in semistructured interviews. Following thematic content analysis by Kuckartz, the interview transcripts were coded for facilitators and barriers for prognostic acceptance. Additionally, patients completed questionnaires on prognostic awareness and sociodemographic characteristics. Results Patients described the following facilitators for prognostic acceptance: social support, positive thinking, focusing on the Here and Now, proactive confrontation, having little to no symptoms, and being there for others. The indicated barriers were distressing physical symptoms and restricted functioning, social distress, and additional distress from other areas of life. Conclusions Patients reported a variety of factors—related to the social realm, symptom burden, and specific attitudes—that help or hinder them in accepting their prognosis. Oncologists and psycho‐oncologists may support prognostic acceptance by encouraging patients to both actively deal with realistic information as well as enjoy pleasant and meaningful moments in the present during which the disease and its prognosis recedes into the background.