Cesar H Gutiérrez-Aguirre1, José C Jaime-Pérez2, Fernando de la Garza-Salazar2, Geraldina Guerrero-González3, Abel Guzmán-López3, Guillermo J Ruiz-Arguelles4, David Gómez-Almaguer2, Olga G Cantú-Rodríguez5. 1. Servicio de Hematología del Hospital Universitario "Dr. José E. González". Universidad Autónoma de Nuevo León. Monterrey N.L., México; Instituto de Investigaciones en Bioética. Monterrey N.L., México. 2. Servicio de Hematología del Hospital Universitario "Dr. José E. González". Universidad Autónoma de Nuevo León. Monterrey N.L., México. 3. Instituto de Investigaciones en Bioética. Monterrey N.L., México. 4. Centro de Hematología y Medicina Interna de Puebla, Puebla, México. 5. Servicio de Hematología del Hospital Universitario "Dr. José E. González". Universidad Autónoma de Nuevo León. Monterrey N.L., México. Electronic address: ogcantur@yahoo.com.mx.
Abstract
BACKGROUND: Hematopoietic stem cell donors (HSCD) could have ambivalent feelings about donation. These feelings are related to moral obligation to help a sick relative and fear about the donation procedure. This can produce moral distress (MD) and anxiety, which are usually unnoticed by the treating physician. OBJECTIVE: The aim of this study was to evaluate the incidence of MD and anxiety in a group of related HSCD for allogeneic transplantation. STUDY DESIGN: A prospective observational study was done. To assess MD and anxiety we applied three self-answered questionnaires (Questionnaire to assess moral distress (MDQ), State Trait Anxiety Index (STAI®) and Edmonton Symptom Assessment System (ESAS)), before, during and after hematopoietic stem cell donation. RESULTS: A total of sixty consecutive related HSCD with a mean age of 38.2 years were included. Thirty-six were male. Hematopoietic stem cell collections were done by apheresis and were performed as an outpatient process in all cases. The incidence of MD during the donation process was 56%. The proportion of HSCD with moderate-high state-anxiety significantly decreased from before (63%) to after donation (30%). Higher scores for MD correlated with higher scores in STAI questionnaires (r=0.448, p< .005). Thirty-seven donors (62%) had at least 1 physical symptom even before the stem cell mobilization process started, mainly anxiety (33%), difficulty sleeping (33%), and fatigue (30%). The number of symptomatic donors increased during donation (100%) and decreased after the procedure (80%). CONCLUSIONS: We conclude that MD and anxiety symptoms experienced by HSCD are very common and his could be explained by mixed feelings about the donation process. We consider that comprehensive psychological support before starting the donation process and guaranteeing respect for the donor's autonomy are needed to decrease the negative impact of the donation experience.
BACKGROUND: Hematopoietic stem cell donors (HSCD) could have ambivalent feelings about donation. These feelings are related to moral obligation to help a sick relative and fear about the donation procedure. This can produce moral distress (MD) and anxiety, which are usually unnoticed by the treating physician. OBJECTIVE: The aim of this study was to evaluate the incidence of MD and anxiety in a group of related HSCD for allogeneic transplantation. STUDY DESIGN: A prospective observational study was done. To assess MD and anxiety we applied three self-answered questionnaires (Questionnaire to assess moral distress (MDQ), State Trait Anxiety Index (STAI®) and Edmonton Symptom Assessment System (ESAS)), before, during and after hematopoietic stem cell donation. RESULTS: A total of sixty consecutive related HSCD with a mean age of 38.2 years were included. Thirty-six were male. Hematopoietic stem cell collections were done by apheresis and were performed as an outpatient process in all cases. The incidence of MD during the donation process was 56%. The proportion of HSCD with moderate-high state-anxiety significantly decreased from before (63%) to after donation (30%). Higher scores for MD correlated with higher scores in STAI questionnaires (r=0.448, p< .005). Thirty-seven donors (62%) had at least 1 physical symptom even before the stem cell mobilization process started, mainly anxiety (33%), difficulty sleeping (33%), and fatigue (30%). The number of symptomatic donors increased during donation (100%) and decreased after the procedure (80%). CONCLUSIONS: We conclude that MD and anxiety symptoms experienced by HSCD are very common and his could be explained by mixed feelings about the donation process. We consider that comprehensive psychological support before starting the donation process and guaranteeing respect for the donor's autonomy are needed to decrease the negative impact of the donation experience.