Positive Psychological Constructs and Health Outcomes in Hematopoietic Stem Cell Transplantation Patients: A Systematic Review

Abstract

A B S T R A C T Positive psychological constructs (eg, optimism, positive affect) have been independently associated with superior health outcomes across many medical populations. However, there has been little synthesis of the literature examining these associations among patients with hematologic malignancies receiving hematopoietic stem cell transplantation (HSCT). To address this gap we completed a systematic review, using Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines, of studies examining relationships between positive psychological constructs and health-related outcomes (eg, psychiatric symptoms, function, health-related quality of life [HRQoL], or treatment compliance) after HSCT. Eighteen eligible studies (N = 4201; 47% women; mean age, 47.1) were identified. Optimism (n = 12 studies) was the most frequently studied positive construct and HRQoL (examined in n = 11 studies) the most common outcome. All 17 studies with quantitative analyses found a significant (P < .05) association between a positive psychological construct and a health outcome; most but not all controlled for 1 or more relevant covariates. Among patients with hematologic malignancies who receive HSCT, positive psychological constructs appear to be associated with improved HRQoL and other health outcomes. Further work is warranted to more comprehensively understand the independent effects of positive psychological constructs on a variety of health outcomes and to develop interventions to promote well-being that are adapted to the needs of this population.

Positive psychological experiences in allogeneic hematopoietic stem cell transplantation

“…As observed in our cohort, other studies with cancer patients have shown the likelihood for optimism to fluctuate over the course of the cancer care continuum . Numerous studies have highlighted prospective associations between optimism and improved outcomes (including lower depression and anxiety, increased quality of life, and decreased mortality) in the HSCT population . Hence, the potential decrease in report of an important positive emotional trait, such as optimism, justifies the need to explore interventions that could boost optimism and other positive traits in this population.…”

“…The deliberate engagement in pleasant and meaningful activities also yielded a variety of positive emotional experiences. While family support may be less modifiable for any given patient, interventions that encourage patients to identify and systematically engage in pleasant and meaningful activities could be especially relevant for HSCT patients …”

“…In this study of 25 allogeneic transplant recipients, we used qualitative interviews to understand and elaborate on the positive psychological experiences at two important periods in the recovery following the transplant. This was, to our knowledge, the first qualitative study to examine positive psychological experiences of allogenic transplant recipients, among the first to explore positive constructs longitudinally via multiple assessments in this population, 6 and to examine explicitly the sources of positive psychological experiences in the context of allogeneic transplantation. 26 We found that beyond positive psychological traits and states such as optimism and positive affect that have been well studied in HSCT patients, our sample reported numerous additional positive constructs such as gratitude, determination, perseverance, feeling blessed, and confidence.…”

“…Different PPWB constructs may have different effects on health and recovery in HSCT patients. Although some prior studies have explored the relationship between a small number of PPWB constructs (such as optimism/hope and positive affect) and health outcomes in this patient population, in depth qualitative studies that focus on the breadth, evolution, and sources of PPWB experiences in this population are lacking. Furthermore, studies on how PPWB constructs relate to partaking in key health behaviors required for successful recovery are limited.…”

“…Psychological factors are very important to HSCT recovery, and the majority of prior studies have examined the impact of negative psychological syndromes. 6 Such studies have found that significant psychological distress accompanies HSCT, and depression, anxiety, or symptoms of posttraumatic stress disorder (PTSD) result in suboptimal health outcomes and increased mortality. 7,8 However, not all patients experience clinical psychiatric disorders in the recovery following a stem cell transplant, yet psychiatric factors can still greatly impact their quality of life and recovery.…”