Introduction

The onset of symptoms and the diagnosis of acute myeloid leukemia (AML) often occur suddenly and may lead to a range of emotional responses. Understanding patients' experiences and emotional states allows clinicians to tailor care to patients' needs. Previous studies have largely focused on patients' experiences at diagnosis and after remission has been achieved among those who received intensive chemotherapy. In this study, we evaluated experiences of older patients with AML who had received or were receiving treatments of varying intensity, in both outpatient and inpatient settings, and who were at different stages in their treatment course at the time of our interviews.

Materials and methods

We conducted a single center qualitative study which aimed to understand factors influencing older patients' treatment decision-making and the findings were previously reported. This analysis specifically explored older patients' experiences at various stages after AML diagnosis. We purposively sampled patients based on treatment intensity and stage of treatment (undergoing induction treatment, post-remission treatment, or post-allogeneic hematopoietic stem cell transplant). We recruited fifteen patients aged ≥60 years with AML. The sample size was determined based on reaching data saturation for the primary study aim. For this analysis, data saturation was reached by the fourteenth manuscript. In-depth semi-structured interviews that had been recorded and transcribed were re-analyzed using inductive thematic analysis to explore patients' experiences. Coding was performed using Atlas.ti. We identified themes with the aim of capturing the most commonly shared experiences.

Results

Mean age of the fifteen patients was 72.1 years; all had received one or more treatments including intensive induction therapy (10/15), lower-intensity treatment (7/15), and/or hematopoietic stem cell transplant (3/15). Patients experienced strong negative emotional responses, including shock, that were barriers to processing information and meaningful communication. Patients also shared their perspectives on communication with healthcare professionals (including thoughts on adequacy of information provided) and coping strategies.

Discussion

Understanding older patients' experiences, including emotional responses and barriers to communication and decision making, at AML diagnosis and throughout the illness trajectory allows clinicians to address patients' supportive care needs during this difficult period.

中文翻译：

---

初步诊断为急性髓性白血病后老年患者的经历：一项定性研究

介绍

急性髓性白血病 (AML) 的症状发作和诊断通常突然发生，并可能导致一系列情绪反应。了解患者的经历和情绪状态可以让临床医生根据患者的需求定制护理。以前的研究主要集中在接受强化化疗的患者在诊断和缓解后的经历上。在这项研究中，我们评估了老年 AML 患者的经历，这些患者在门诊和住院环境中接受过或正在接受不同强度的治疗，并且在我们采访时处于治疗过程的不同阶段。

材料和方法

我们进行了一项单中心定性研究，旨在了解影响老年患者治疗决策的因素，研究结果之前已报告。该分析专门探讨了老年患者在 AML 诊断后各个阶段的经历。我们根据治疗强度和治疗阶段（接受诱导治疗、缓解后治疗或异基因造血干细胞移植后）有目的地对患者进行抽样。我们招募了 15 名年龄≥60 岁的 AML 患者。样本量是根据达到主要研究目标的数据饱和度来确定的。对于这个分析，第十四份手稿达到了数据饱和。使用归纳主题分析对已记录和转录的深度半结构化访谈进行重新分析，以探索患者的经历。使用 Atlas.ti 进行编码。我们确定主题是为了捕捉最常见的共享体验。

结果

15 名患者的平均年龄为 72.1 岁；所有人都接受了一种或多种治疗，包括强化诱导治疗 (10/15)、低强度治疗 (7/15) 和/或造血干细胞移植 (3/15)。患者经历了强烈的负面情绪反应，包括震惊，这是处理信息和进行有意义的交流的障碍。患者还分享了他们对与医疗保健专业人员沟通的看法（包括对所提供信息的充分性的看法）和应对策略。

讨论

了解老年患者在 AML 诊断和整个疾病轨迹中的经历，包括情绪反应以及沟通和决策障碍，可以让临床医生在这个困难时期解决患者的支持性护理需求。