Applying Evidence to Support Meaning-Making Post-Transplant
Imagine your patient is a woman 13 months post-allogeneic matched sibling transplant using peripheral blood stem cells (PBSC). Her physical recovery is going well, with only minor bouts of graft-versus-host disease (GVHD). She’s gained strength and returned to work part-time. After visiting with her physician, she confides in you that she feels like she’s being “fake” with friends. She thought she could just be the same as she was before the transplant, but now is questioning whether that’s possible. She’s afraid she’ll lose friends if she is her real self. How do you respond?
The Illness Trajectory Framework, originally described by Corbin and Strauss, can be applied to the experience of survivorship after serious illness and treatment. [1,2] This framework describes the importance of biographical work, or “reconstructing one’s identity and self-concept.”  To accomplish this work, a person must make sense of their experience and incorporate it into their identity.  This can happen through meaning-making exercises, such as reflective writing, which has been shown to have a positive impact on coping among transplant survivors.  Additionally, a sense of closure, for example through a discharge appointment, may help people define and frame the experience. However, chronic GVHD treatment can last years, making closure difficult to attain.
Application to Practice
Using the Illness Trajectory Framework to inform your reply, you guide her to reflect on her point of view about her transplant experience. Help her consider how her diagnosis and treatment impacted herself, family and personal relationships with others, including her strengths she brought to the situation. Through this therapeutic dialogue you can encourage meaning-making while also recognizing her suffering, promoting coherence and supporting social connections.  She may also benefit from talking with other transplant recipients who have experienced similar challenges incorporating themselves into their post-transplant life. You encourage her to tell you more about how she’s feeling, what her situation means for her, actively listen and validate her experiences. She thanks you for listening and asks if there is anything she can do. Based on the evidence, a few resources you may offer include:
- One-on-one counseling
- Peer support
- Tools and resources for reflective writing and expression
Resources for your patients
Through the Be The Match Patient Support Center, your patients and their caregivers can access free programs that support meaning-making:
- The BMT Journeys project invites transplant recipients, caregivers or parent caregivers to submit a work of written or visual art. Share this flyer with your patients and caregivers and download the Reflective Writing Guide. Learn more at BeTheMatch.org/BMTJourneys
- Through our Counseling Services, a licensed social worker provides one-on-one telephone counseling support to help transplant patients, recipients and caregivers cope with transplant and recovery. Learn more at BeTheMatch.org/Counseling
- The Peer Connect program connects patients, recipients or caregivers by phone and email with a trained volunteer who is a transplant recipient or caregiver. Your patients and caregivers can request a connection at BeTheMatch.org/PeerConnect
- Telephone-based support groups are held monthly and provide transplant recipients time to connect with others who understand the experience in ways other people might not. Email firstname.lastname@example.org for more information on dates and times.
- Corbin, J.M., & Strauss, A. (1988). Unending Work and Care: Managing Chronic Illness at Home. San Francisco: Jossey-Bass Publishers.
- Klimmek, R., & Wenzel, J. (2012). Adaptation of the Illness Trajectory Theory to Describe the Work of Transitional Cancer Survivorship. Oncology Nursing Forum, 39(6), E499–E510. Access
- Adelstein, K., Anderson, J., & Taylor, A. (2014). Importance of Meaning-Making for Patients Undergoing Hematopoietic Stem Cell Transplantation. Oncology Nursing Forum, 41(2), E172 – 184. Access
- Lethborg, C., & Harms, L. (2015). Meaning-making approaches to social work practice in oncology. In G. Christ, C. Messner, & L. Behar (Eds.), Handbook of Oncology Social Work Psychosocial Care for People with Cancer (351-356). New York City, NY: Oxford University Press.