Symptom clusters and help-seeking behaviours during neutropenia after autologous haematopoietic stem cell transplantation: A qualitative study to inform oncology nursing support

Abstract

Purpose To explore how adult autologous haematopoietic stem cell transplantation recipients experience and appraise symptom constellations during neutropenia, and how these appraisals shape help-seeking and interactions with clinicians. Methods A qualitative descriptive study was conducted in an inpatient haematopoietic stem cell transplantation unit in Wuxi, China. Adults aged 18 years or older who had undergone autologous transplantation and were neutropenic were purposively sampled to maximise variation. Semi-structured interviews were audio-recorded, transcribed verbatim, and analysed using reflexive thematic analysis. Results Twenty-two participants were interviewed between post-transplant day + 5 and +18. Participants described symptoms as interlocking constellations rather than isolated events. They differentiated expected treatment-related toxicities from possible deterioration by attending to symptom trajectories, including worsening intensity, new symptom combinations, or symptoms that felt different from the previous day. Fever-related patterns usually prompted immediate escalation. Help-seeking ranged from prompt reporting to watchful waiting, self-management followed by reporting, or withholding. These responses were shaped by uncertainty, perceived legitimacy of concerns, and reluctance to bother staff during protective isolation. Conclusions Symptom constellations and symptom trajectories shaped urgency appraisal and help-seeking during inpatient neutropenia after autologous haematopoietic stem cell transplantation. Cluster-informed assessment and escalation coaching may support timelier reporting and safer supportive care in protective isolation.