Volume 31, Issue 2
  • ISSN 1387-6740
  • E-ISSN: 1569-9935
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Purpose: The purpose of this study was to qualitatively analyze metacommunication during the digital storytelling (DST) workshop process for patients undergoing hematopoietic cell transplantation (HCT).

Methods: HCT survivors who had undergone transplant within the past 2 years were recruited at a cancer center in the Phoenix Metropolitan area. Participants ( age = 51.5 years) attended a 3-day DST workshop telling and creating digital stories around their HCT experiences. Using a constructivist grounded theory approach, line by line coding and content analysis were conducted with four research team members.

Results: Four themes emerged from the data: (1) communal connection; (2) expressing and processing emotions; (3) self-empowerment; and (4) multi-dimensional coping. Participants described telling and sharing their story with other HCT patients as therapeutic.

Conclusion: DST shows promise as a potential coping tool and offers multiple dimensions of the role of narrative as a coping technique, in community building, and in patient-centered contexts within HCT.


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  1. Andersen, B. L. , Thornton, L. M. , Shapiro, C. L. , Farrar, W. B. , Mundy, B. L. , Yang, H. C. , & Carson, W. E.
    (2010) Biobehavioral, immune, and health benefits following recurrence for psychological intervention participants. Clinical Cancer Research, 16(12), 3270–3278. doi:  10.1158/1078‑0432.CCR‑10‑0278
    https://doi.org/10.1158/1078-0432.CCR-10-0278 [Google Scholar]
  2. Anderson, J. O. , & Martin, P. G.
    (2003) Narratives and healing: exploring one family’s stories of cancer survivorship. Health Communication, 15(2), 133–143. doi:  10.1207/S15327027HC1502_2 [doi]
    https://doi.org/10.1207/S15327027HC1502_2 [Google Scholar]
  3. Andrykowski, M. A.
    (1994a) Psychiatric and psychosocial aspects of bone marrow transplantation. Psychosomatics, 35(1), 13–24. doi:  10.1016/S0033‑3182(94)71803‑X [pii]
    https://doi.org/10.1016/S0033-3182(94)71803-X [Google Scholar]
  4. (1994b) Psychosocial factors in bone marrow transplantation: a review and recommendations for research. Bone Marrow Transplant, 13(4), 357–375.
    [Google Scholar]
  5. Atkinson, S. , & Rubinelli, S.
    (2012) Narrative in cancer research and policy: voice, knowledge and context. Critical Reviews in Oncology/Hematology, 84 (Suppl 2), S11–16. doi:  10.1016/S1040‑8428(13)70004‑0 [doi]
    https://doi.org/10.1016/S1040-8428(13)70004-0 [Google Scholar]
  6. Bandura, A.
    (1986) Social foundations of thought and action. Englewood Cliffs, NJ: Prentice Hall.
    [Google Scholar]
  7. Cameron, L. D. , Leventhal, H. , & Love, R. R.
    (1998) Trait anxiety, symptom perceptions, and illness-related responses among women with breast cancer in remission during a tamoxifen clinical trial. Health Psychology, 17(5), 459–469. 10.1037/0278‑6133.17.5.459
    https://doi.org/10.1037/0278-6133.17.5.459 [Google Scholar]
  8. Campbell, J. L. , Quincy, C. , Osserman, J. , & Pedersen, O. K.
    (2013) Coding In-depth Semistructured Interviews:Problems of Unitization and Intercoder Reliability and Agreement. Sociological Methods & Research, 42(3), 294–320. doi:  10.1177/0049124113500475
    https://doi.org/10.1177/0049124113500475 [Google Scholar]
  9. Carlick, A. , & Biley, F. C.
    (2004a) Thoughts on the therapeutic use of narrative in the promotion of coping in cancer care. European Journal of Cancer Care, 13(4), 308–317. doi: 10.1111/j.1365‑2354.2004.00466.x
    https://doi.org/10.1111/j.1365-2354.2004.00466.x [Google Scholar]
  10. (2004b) Thoughts on the therapeutic use of narrative in the promotion of coping in cancer care. European Journal of Cancer Care, 13(4), 308–317. 10.1111/j.1365‑2354.2004.00466.x
    https://doi.org/10.1111/j.1365-2354.2004.00466.x [Google Scholar]
  11. Charmaz, K.
    (2006) Constructing grounded theory: A practical guide through qualitative analysis. London: Sage Publications.
    [Google Scholar]
  12. Cooke, L. , Gemmill, R. , Kravits, K. , & Grant, M.
    (2009) Psychological issues of stem cell transplant. Seminars in Oncology Nursing, 25(2), 139–150. doi:  10.1016/j.soncn.2009.03.008
    https://doi.org/10.1016/j.soncn.2009.03.008 [Google Scholar]
  13. Copelan, E. A.
    (2006) Hematopoietic stem-cell transplantation. New England Journal of Medicine, 354(17), 1813–1826. 10.1056/NEJMra052638
    https://doi.org/10.1056/NEJMra052638 [Google Scholar]
  14. Creswell, J. W.
    (2009) Research Design: Qualitative, Quantitative, and Mixed Methods Approaches (3rd ed.). Thousand Oaks, Calif.: Sage Publications.
    [Google Scholar]
  15. Crogan, N. L. , Evans, B. C. , & Bendel, R.
    (2008) Storytelling intervention for patients with cancer: part 2-pilot testing. Oncology Nursing Forum, 35(2), 265–272. doi:  10.1188/08.ONF.265‑272
    https://doi.org/10.1188/08.ONF.265-272 [Google Scholar]
  16. DiFulvio, G. T. , Gubrium, A. C. , Fiddian-Green, A. , Lowe, S. E. , & Del Toro-Mejias, L. M.
    (2016) Digital storytelling as a narrative health promotion process: Evaluation of a pilot study. International Quarterly of Community Health Education, 36(3), 157–164. 10.1177/0272684X16647359
    https://doi.org/10.1177/0272684X16647359 [Google Scholar]
  17. Dwight-Johnson, M. , Ell, K. , & Lee, P. J.
    (2005) Can collaborative care address the needs of low-income Latinas with comorbid depression and cancer? Results from a randomized pilot study. Psychosomatics, 46(3), 224–232. doi:  10.1176/appi.psy.46.3.224
    https://doi.org/10.1176/appi.psy.46.3.224 [Google Scholar]
  18. Ell, K. , Sanchez, K. , Vourlekis, B. , Lee, P. J. , Dwight-Johnson, M. , Lagomasino, I. , Russell, C.
    (2005) Depression, correlates of depression, and receipt of depression care among low-income women with breast or gynecologic cancer. Journal of Clinical Oncology, 23(13), 3052–3060. doi:  10.1200/JCO.2005.08.041
    https://doi.org/10.1200/JCO.2005.08.041 [Google Scholar]
  19. Fiddian-Green, A. , Kim, S. , Gubrium, A. C. , Larkey, L. K. , & Peterson, J. C.
    (2019) Restor (y) ing Health: A Conceptual Model of the Effects of Digital Storytelling. Health Promotion Practice, 20(4), 1–11. doi:  10.1177/1524839918825130
    https://doi.org/10.1177/1524839918825130 [Google Scholar]
  20. Gooley, T. A. , Chien, J. W. , Pergam, S. A. , Hingorani, S. , Sorror, M. L. , Boeckh, M. , Appelbaum, F. R.
    (2010) Reduced mortality after allogeneic hematopoietic-cell transplantation. New England Journal of Medicine, 363(22), 2091–2101. 10.1056/NEJMoa1004383
    https://doi.org/10.1056/NEJMoa1004383 [Google Scholar]
  21. Green, M. C. , & Brock, T. C.
    (2000) The role of transportation in the persuasiveness of public narratives. Journal of Personality and Social Psychology, 79(5), 701–721. 10.1037/0022‑3514.79.5.701
    https://doi.org/10.1037/0022-3514.79.5.701 [Google Scholar]
  22. Gubrium, A. , Fiddian-Green, A. , Lowe, S. , DiFulvio, G. , & Del Toro-Mejias, L.
    (2016) Measuring Down: Evaluating Digital Storytelling as a Process for Narrative Health Promotion. Qualitative Health Research, 26(13), 1–15. doi:  10.1177/1049732316649353
    https://doi.org/10.1177/1049732316649353 [Google Scholar]
  23. Gubrium, A.
    (2009) Digital storytelling: An emergent method for health promotion research and practice. Health Promotion Practice, 10(2), 186–191. 10.1177/1524839909332600
    https://doi.org/10.1177/1524839909332600 [Google Scholar]
  24. Gubrium, A. , Fiddian-Green, A. , Lowe, S. , DiFulvio, G. , & Peterson, J.
    (2019) Digital storytelling as critical narrative intervention with adolescent women of Puerto Rican descent. Critical Public Health, 29(3), 290–301. 10.1080/09581596.2018.1451622
    https://doi.org/10.1080/09581596.2018.1451622 [Google Scholar]
  25. Han, W. T. , Collie, K. , Koopman, C. , Azarow, J. , Classen, C. , Morrow, G. R. , Spiegel, D.
    (2005) Breast cancer and problems with medical interactions: relationships with traumatic stress, emotional self-efficacy, and social support. Psychooncology, 14(4), 318–330. doi:  10.1002/pon.852
    https://doi.org/10.1002/pon.852 [Google Scholar]
  26. Hatzimichael, E. , & Tuthill, M.
    (2010) Hematopoietic stem cell transplantation. Stem Cells and Cloning: Advances and Applications, 3(1), 105–117. doi:  10.2147/SCCAA.S6815
    https://doi.org/10.2147/SCCAA.S6815 [Google Scholar]
  27. Hinyard, L. J. , & Kreuter, M. W.
    (2007) Using Narrative Communication as a Tool for Health Behavior Change: A Conceptual, Theoretical, and Empirical Overview. Health Education & Behavior, 34(5), 777–792. doi:  10.1177/1090198106291963
    https://doi.org/10.1177/1090198106291963 [Google Scholar]
  28. Houston, T. K.
    (2011) The Art and Science of Patient Storytelling – Harnessing Narrative Communication for Behavioral Interventions: The ACCE Project. Journal of Health Communication, 16(7), 686–697. doi: 10.1080/10810730.2011.551997
    https://doi.org/10.1080/10810730.2011.551997 [Google Scholar]
  29. Houston, T. K. , Cherrington, A. , Coley, H. L. , Robinson, K. M. , Trobaugh, J. A. , Williams, J. H. , Allison, J. J.
    (2011) The art and science of patient storytelling-harnessing narrative communication for behavioral interventions: the ACCE project. Journal of Health Communication, 16(7), 686–697. doi:  10.1080/10810730.2011.551997
    https://doi.org/10.1080/10810730.2011.551997 [Google Scholar]
  30. Hoybye, M. T. , Johansen, C. , & Tjornhoj-Thomsen, T.
    (2005) Online interaction. Effects of storytelling in an internet breast cancer support group. Psychooncology, 14(3), 211–220. doi:  10.1002/pon.837
    https://doi.org/10.1002/pon.837 [Google Scholar]
  31. Kazi, A.
    (2008) Psychological and physical adjustment to breast cancer over 12 months following a cognitive behavioral stress management intervention: identifying different trajectories of change. (Doctor of Philosophy), University of Miami, Coral Gables, FL.
    [Google Scholar]
  32. Kressler, J.
    (2014) Women’s stories of breast cancer: sharing information through YouTube video blogs. University of Western Ontario, London, Canada.
    [Google Scholar]
  33. Kreuter, M. W. , Green, M. C. , Cappella, J. N. , Slater, M. D. , Wise, M. E. , Storey, D. , Holmes, K.
    (2007) Narrative communication in cancer prevention and control: a framework to guide research and application. Annals of Behavioral Medicine, 33(3), 221–235. 10.1007/BF02879904
    https://doi.org/10.1007/BF02879904 [Google Scholar]
  34. Lambert, J.
    (2012) Digital storytelling: Capturing lives, creating community. Abingdon-on-Thames: Routledge.
    [Google Scholar]
  35. Langer Kelly, T. H. , Storer, B. E. , Hall, S. P. , Lucas, H. G. , & Syrjala, K. L.
    (2012) Expressive talking among caregivers of hematopoietic stem cell transplant survivors: acceptability and concurrent subjective, objective, and physiologic indicators of emotion. Journal of Psychosocial Oncology, 30(3), 294–315. 10.1080/07347332.2012.664255
    https://doi.org/10.1080/07347332.2012.664255 [Google Scholar]
  36. Larkey , & Hill, A.
    (2012) Using narratives to promote health: a culture-centric approach. In H. Cho (Ed.), Health Communication Message Design: Theory and Practice (pp.95–112). Los Angeles, CA: Sage Publications.
    [Google Scholar]
  37. Larkey, L. , Del Toro-Mejías, L. , DiFulvio, G. , & Gubrium, A.
    (2018) Narrative influences on “desire to act in my community” in digital storytelling workshops for Latina teens. International Quarterly of Community Health Education, 38(3), 163–167. 10.1177/0272684X18759927
    https://doi.org/10.1177/0272684X18759927 [Google Scholar]
  38. Larkey, L. K. , & Hecht, M.
    (2010) A model of effects of narrative as culture-centric health promotion. Journal of Health Communication, 15(2), 114–135. 10.1080/10810730903528017
    https://doi.org/10.1080/10810730903528017 [Google Scholar]
  39. Lemieux, J. , Beaton, D. E. , Hogg-Johnson, S. , Bordeleau, L. J. , Hunter, J. , & Goodwin, P. J.
    (2007) Responsiveness to change to change due to supportive-expressive group therapy, improvement in mood and disease progression in women with metastatic breast cancer. Quality of Life Research, 16(6), 1007–1017. 10.1007/s11136‑007‑9208‑2
    https://doi.org/10.1007/s11136-007-9208-2 [Google Scholar]
  40. Lloyd-Williams, M. , Cobb, M. , O’Connor, C. , Dunn, L. , & Shiels, C.
    (2013) A pilot randomised controlled trial to reduce suffering and emotional distress in patients with advanced cancer. Journal of Affective Disorders, 148(1), 141–145. doi:  10.1016/j.jad.2012.11.013
    https://doi.org/10.1016/j.jad.2012.11.013 [Google Scholar]
  41. Manne, S. , Ostroff, J. , Winkel, G. , Goldstein, L. , Fox, K. , & Grana, G.
    (2004) Posttraumatic growth after breast cancer: patient, partner, and couple perspectives. Psychosomatic Medicine, 66(3), 442–454.
    [Google Scholar]
  42. Martin, S. L. , McLean, J. , Brooks, C. , & Wood, K.
    (2019) “I’ve Been Silenced for so Long”: Relational Engagement and Empowerment in a Digital Storytelling Project With Young Women Exposed to Dating Violence. International Journal of Qualitative Methods, 18, 1–12. doi:  10.1177/1609406919825932
    https://doi.org/10.1177/1609406919825932 [Google Scholar]
  43. McQueen, A. , Kreuter, M. W. , Kalesan, B. , & Alcaraz, K. I.
    (2011) Understanding narrative effects: the impact of breast cancer survivor stories on message processing, attitudes, and beliefs among African American women. Health Psychology: Official Journal of the Division of Health Psychology, American Psychological Association, 30(6), 674–682. doi:  10.1037/a0025395
    https://doi.org/10.1037/a0025395 [Google Scholar]
  44. Mosher, C. E. , DuHamel, K. N. , Rini, C. , Corner, G. , Lam, J. , & Redd, W. H.
    (2011) Quality of life concerns and depression among hematopoietic stem cell transplant survivors. Support Care Cancer, 19(9), 1357–1365. doi:  10.1007/s00520‑010‑0958‑y
    https://doi.org/10.1007/s00520-010-0958-y [Google Scholar]
  45. Mosher, C. E. , Redd, W. H. , Rini, C. M. , Burkhalter, J. E. , & DuHamel, K. N.
    (2009) Physical, psychological, and social sequelae following hematopoietic stem cell transplantation: a review of the literature. Psychooncology, 18(2), 113–127. doi:  10.1002/pon.1399
    https://doi.org/10.1002/pon.1399 [Google Scholar]
  46. Niederwieser, D. , Baldomero, H. , Szer, J. , Gratwohl, M. , Aljurf, M. , Atsuta, Y. , Gratwohl, A.
    (2016) Hematopoietic stem cell transplantation activity worldwide in 2012 and a SWOT analysis of the Worldwide Network for Blood and Marrow Transplantation Group including the global survey. Bone Marrow Transplant, 51(6), 778–785. doi:  10.1038/bmt.2016.18
    https://doi.org/10.1038/bmt.2016.18 [Google Scholar]
  47. Park-Fuller, L. M.
    (2000) Performing absence: The staged personal narrative as testimony. Text and Performance Quarterly, 20(1), 20–42. 10.1080/10462930009366281
    https://doi.org/10.1080/10462930009366281 [Google Scholar]
  48. Pasquini, M. C. , Wang, Z. , Horowitz, M. M. , & Gale, R. P.
    (2010) 2010 report from the Center for International Blood and Marrow Transplant Research (CIBMTR): current uses and outcomes of hematopoietic cell transplants for blood and bone marrow disorders. Clinical transplants, 87–105.
    [Google Scholar]
  49. Paterno, M. T. , Fiddian-Green, A. , & Gubrium, A.
    (2018) Moms Supporting Moms: Digital Storytelling With Peer Mentors in Recovery From Substance Use. Health Promotion Practice, 19(9), 545–556. doi:  10.1177/1524839917750816
    https://doi.org/10.1177/1524839917750816 [Google Scholar]
  50. Pennebaker, J. W. , & Chung, C. K.
    (2011) Expressive writing: Connections to physical and mental health. In H. S. Friedman (Ed.), Oxford Handbook of Health Psychology (pp.417–437). Oxford: Oxford University Press.
    [Google Scholar]
  51. Pennebaker, J. W. , & Evans, J. F.
    (2014) Expressive writing: Words that heal. Washington: Idyll Arbor, Incorporated.
    [Google Scholar]
  52. Pidala, J. , Anasetti, C. , & Jim, H.
    (2010) Health-related quality of life following haematopoietic cell transplantation: patient education, evaluation and intervention. British Journal of Haematology, 148(3), 373–385. 10.1111/j.1365‑2141.2009.07992.x
    https://doi.org/10.1111/j.1365-2141.2009.07992.x [Google Scholar]
  53. Riessman, C. K.
    (2008) Narrative methods for the human sciences. Los Angeles, CA: Sage Publications.
    [Google Scholar]
  54. Rini, C. , Austin, J. , Wu, L. M. , Winkel, G. , Valdimarsdottir, H. , Stanton, A. L. , Redd, W. H.
    (2014) Harnessing benefits of helping others: A randomized controlled trial testing expressive helping to address survivorship problems after hematopoietic stem cell transplant. Health Psychology, 33(12), 1541–1551. 10.1037/hea0000024
    https://doi.org/10.1037/hea0000024 [Google Scholar]
  55. Shaffer, V. V. A.
    (2013) The Effect of Narrative Information in a Publicly Available Patient Decision Aid for Early-Stage Breast Cancer. Health Communication, 29(1), 64–73. doi:  10.1080/10410236.2012.717341pmid:
    https://doi.org/10.1080/10410236.2012.717341 [Google Scholar]
  56. Sharf, B. F. , & Vanderford, M. L.
    (2003) Illness narratives and the social construction of health. In T. L. Thompson , A. Dorsey , R. Parrott & K. Miller (Eds.), The Routledge Handbook of Health Communication (pp.9–34). Abingdon-on-Thames: Routledge.
    [Google Scholar]
  57. Stanton, A. L. , Danoff-Burg, S. , Cameron, C. L. , Bishop, M. , Collins, C. A. , Kirk, S. B. , Twillman, R.
    (2000) Emotionally expressive coping predicts psychological and physical adjustment to breast cancer. Journal of Consulting and Clinical Psychology, 68(5), 875. 10.1037/0022‑006X.68.5.875
    https://doi.org/10.1037/0022-006X.68.5.875 [Google Scholar]
  58. Stanton, A. L.
    (2011) Regulating emotions during stressful experiences: The adaptive utility of coping through emotional approach. In S. Folkman (Ed.), The Oxford Handbook of Stress, Health, and Coping (pp.369–386). Oxford: Oxford University Press.
    [Google Scholar]
  59. Sun, C. L. , Francisco, L. , Baker, K. S. , Weisdorf, D. J. , Forman, S. J. , & Bhatia, S.
    (2011) Adverse psychological outcomes in long-term survivors of hematopoietic cell transplantation: a report from the Bone Marrow Transplant Survivor Study (BMTSS). Blood, 118(17), 4723–4731. doi:  10.1182/blood‑2011‑04‑348730
    https://doi.org/10.1182/blood-2011-04-348730 [Google Scholar]
  60. Valsiner, J. , & Branco, A. U.
    (2006) Communication and metacommunication in human development. Charlotte, North Carolina: IAP.
    [Google Scholar]
  61. Visser, M. R. , & Smets, E. M.
    (1998) Fatigue, depression and quality of life in cancer patients: how are they related?Support Care Cancer, 6(2), 101–108. 10.1007/s005200050142
    https://doi.org/10.1007/s005200050142 [Google Scholar]
  62. Wexler, L. , Gubrium, A. , Griffin, M. , & DiFulvio, G.
    (2013) Promoting positive youth development and highlighting reasons for living in Northwest Alaska through digital storytelling. Health Promotion Practice, 14(4), 617–623. doi: 10.1177/1524839912462390; 10.1177/1524839912462390
    https://doi.org/10.1177/1524839912462390 [Google Scholar]
  63. Wingard, J. R. , Majhail, N. S. , Brazauskas, R. , Wang, Z. , Sobocinski, K. A. , Jacobsohn, D. , Rizzo, J. D.
    (2011) Long-term survival and late deaths after allogeneic hematopoietic cell transplantation. Journal of Clinical Oncology, 29(16), 2230–2239. 10.1200/JCO.2010.33.7212
    https://doi.org/10.1200/JCO.2010.33.7212 [Google Scholar]

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