October 3 , 2007. 3:00-4:30pm. Porter Hall 223D, Carnegie Mellon University

Perceptions of Risk for Infection among Older Cancer Patients:
Mismatched Narratives with Unhappy Endings

Presenter: Margaret H. Crighton, PhD, RN, Department of Acute/Tertiary Care, University of Pittsburgh School of Nursing

Neutropenia is a common and deadly cancer treatment side effect that leaves patients at risk for life threatening infection. Clinicians typically ascribe to the biomedical definition of neutropenia as an absolute neutrophil count that represents varying degrees of risk for infection. Their assessment and interventions for neutropenic cancer patients tend to hinge on where patients lie along the safe - danger zone of the neutrophil count and whether or not they have a fever, the hallmark of infection in cancer care. Our research takes a different approach and seeks to understand neutropenia from the patient’s perspective-as a symptom experience-not as a number. Interestingly, patients have not viewed neutropenia as a number, but as an idea, “susceptibility to infection.” A summary of our research to date demonstrates that even older adults with cancer who do not meet the clinical definition of “neutropenia” (an absolute neutrophil count (ANC) less than 2000mm3) nonetheless experience physical and psychosocial symptoms related to it. A qualitative approach using interview, observation and document review in two different settings demonstrated that symptom self monitoring and decision – making associated with NTP - related symptoms, and patient (mis)communication with clinicians about such symptoms, have been accompanied by symptom misinterpretation, delayed medical evaluation, and unplanned hospitalization. The presentation concludes with plans for future intervention development to improve patient self monitoring, decision making and communication about NTP -related symptoms that warrant medical evaluation.