RETURNING TO NORMAL FOLLOWING BONE-MARROW TRANSPLANTATION - OUTCOMES,EXPECTATIONS AND INFORMED CONSENT

The psychosocial impact of bone marrow transplantation (BMT) was inves tigated in 172 disease-free adult BMT survivors drawn from five differ ent BMT treatment centers. Respondents were a mean of 43.5 months afte r BMT, Both questionnaire and interview assessments were utilized, Sur vivors' perceptions of whether they had 'returned to normal' following BMT, recollections of pre-BMT expectations for returning to normal an d current psychological distress were assessed. The results indicated that only a minority of respondents considered themselves to have 'ret urned to normal' following BMT, Reports of less than normal physical, cognitive, occupational, sexual and/or interpersonal functioning were common, In contrast, few patients reported pre-BMT expectations for su ch, Discordance between pre-BMT expectations for returning to normal a nd current functional status was associated with greater current psych ological distress, Finally, despite the presence of any functional def icits and despite any discordance between pre-BMT expectations and cur rent functional status, survivors' evaluations of their decision to pu rsue BMT were generally quite positive, Results are discussed in terms of their implications for: (1) the process of obtaining informed cons ent for BMT, and (2) clinical strategies for enhancing post-BMT psycho logical adjustment.