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Financial burden after allogeneic hematopoietic cell transplantation: a qualitative analysis from the patient’s perspective

Bone Marrow Transplantation volume 50, pages 1259–1261 (2015)Cite this article

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Hematopoietic cell transplantation (HCT) is an intensive, medically complicated and potentially life-threatening therapy with a prolonged trajectory of recovery. Like financial toxicity in cancer, adverse financial consequences of HCT are emerging as an important issue, and may be associated with poor quality of life and increased distress in HCT survivors.1, 2 Financial burden is difficult to assess quantitatively as it is influenced by an individual’s perception of what he or she considers to be a burden. Qualitative research methods can be used to collect information about patients’ perceptions of reasons for their financial distress and to ask them what tangible support would benefit them. This can eventually help to design intervention studies.

In our pilot study evaluating financial burden after HCT, we used a qualitative research methodology to reach a deeper and richer understanding of patients’ perceptions about financial difficulties as a result of HCT. A 25-item self-administered questionnaire was mailed to 482 study patients who had received an allogeneic HCT between January 2006 and June 2012 at the three Mayo Clinic sites: Rochester (MN), Phoenix (AZ) and Jacksonville (FL) and were alive, with a current address available. The study was approved by the Institutional Review Board at Mayo Clinic. The survey methodology and quantitative results have been described in detail previously.1 The questionnaire included an open-ended question: ‘How has transplant made an impact on your financial situation? Please let us know if any particular information could have been provided to you before the transplant that would have helped you plan your finances better for your post-transplant care’. The textual data obtained from this question from 46% of the 268 respondents (n=124) were analyzed with a constant comparative analysis. There were no significant differences in sociodemographic characteristics of this subset and the respondents who did not provide narrative comments (Table 1). Two qualitative researchers and one clinician familiar with qualitative analysis techniques coded the transcripts generated and arrived at the codes after mutual discussion. In addition, qualitative reliability and validity criteria suggested by Creswell and Plano Clark were utilized to ensure data triangulation and inter-coder agreement.3

Table 1 Comparison of sociodemographic profile of respondents who provided narrative comments versus those who did not
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Authors and Affiliations

  1. College of Nursing and Health Innovation, Arizona State University, Phoenix, AZ, USA

    W Kim & J McNulty

  2. Division of Biostatistics, Mayo Clinic, Phoenix, AZ, USA

    Y-H Chang

  3. Division of Hematology/Oncology, Mayo Clinic, Phoenix, AZ, USA

    M Weise & N Khera

  4. Division of Hematology/Oncology, Mayo Clinic, Rochester, MN, USA

    S Hashmi

  5. Division of Hematology/Oncology, Mayo Clinic, Jacksonville, FL, USA

    S Ailawadhi

Authors
  1. W Kim
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  2. J McNulty
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  3. Y-H Chang
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  4. M Weise
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  5. S Hashmi
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  6. S Ailawadhi
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  7. N Khera
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Correspondence to N Khera.

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The authors declare no conflict of interest.

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Kim, W., McNulty, J., Chang, YH. et al. Financial burden after allogeneic hematopoietic cell transplantation: a qualitative analysis from the patient’s perspective. Bone Marrow Transplant 50, 1259–1261 (2015). https://doi.org/10.1038/bmt.2015.128

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