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Learn more: PMC Disclaimer | PMC Copyright Notice Psychooncology . 2026 Apr 13;35(4):e70448. doi: 10.1002/pon.70448 Search in PMC Search in PubMed View in NLM Catalog Add to search Psychosocial Impact Following Acute Hospitalization Among Patients With Hematologic Malignancies and Their Family Caregivers: A Content Analysis Sydney Sumrall Sydney Sumrall 1 Department of Psychology, Virginia Commonwealth University, Richmond, Virginia, USA Find articles by Sydney Sumrall 1 , Rebecca Hoppe Rebecca Hoppe 2 Department of Psychology, Arizona State University, Tempe, Arizona, USA Find articles by Rebecca Hoppe 2 , Julia Slack Julia Slack 3 Duke University, School of Nursing, Durham, North Carolina, USA Find articles by Julia Slack 3 , Youran Lee Youran Lee 3 Duke University, School of Nursing, Durham, North Carolina, USA Find articles by Youran Lee 3 , Tara A Albrecht Tara A Albrecht 4 Advocate Health, Milwaukee, Wisconsin, USA Find articles by Tara A Albrecht 4 , Marcia A Winter Marcia A Winter 1 Department of Psychology, Virginia Commonwealth University, Richmond, Virginia, USA Find articles by Marcia A Winter 1, ✉ Author information Article notes Copyright and License information 1 Department of Psychology, Virginia Commonwealth University, Richmond, Virginia, USA 2 Department of Psychology, Arizona State University, Tempe, Arizona, USA 3 Duke University, School of Nursing, Durham, North Carolina, USA 4 Advocate Health, Milwaukee, Wisconsin, USA * Correspondence: Marcia A. Winter, ( [email protected] ) ✉ Corresponding author. Revised 2025 Dec 20; Received 2025 Feb 26; Accepted 2026 Mar 30; Issue date 2026 Apr. © 2026 The Author(s). Psycho‐Oncology published by John Wiley & Sons Ltd. This is an open access article under the terms of the http://creativecommons.org/licenses/by-nc-nd/4.0/ License, which permits use and distribution in any medium, provided the original work is properly cited, the use is non‐commercial and no modifications or adaptations are made. PMC Copyright notice PMCID: PMC13075462 PMID: 41973346 ABSTRACT Background Hematologic malignancies (HMs) require intensive treatment procedures which significantly reduce quality of life for patients. Patients with HM often rely on family caregivers to provide emotional and instrumental support. It is therefore essential to understand patients' and caregivers' experiences to inform psychosocial interventions. Aims This study explores the impact of HM on patients' and caregivers' lived experiences during the acute treatment period. Methods Interview responses from patients with HM ( n = 24) and their caregivers ( n = 24) were coded via content analysis to describe the meaning that participants assigned to their experiences, and code frequencies were calculated. Results Results identified themes of emotional, physical, logistical, and financial impacts of the disease as well as supports and challenges in families' interactions with the healthcare system. Patients most frequently discussed the physical impact of their illness, while caregivers made the most comments about their relationship with healthcare providers. Conclusions Findings underscore patient, caregivers, and healthcare team successes and challenges as well as the need for early interventions that help families feel more prepared to cope with cumulative strains of cancer treatment and caregiving. 1. Background Hematologic malignancies (HMs), including leukemias, lymphomas, and multiple myeloma, are life‐threatening cancers affecting the blood, bone marrow, and lymph nodes. HMs account for approximately 9% of all cancers. An estimated 187,740 individuals in the United States are expected to be diagnosed with a HM in 2024, and approximately 1,698,339 individuals are living with or in remission from a HM [ 1 ]. Patients with these cancers receive intensive chemotherapy and tend to require more inpatient hospitalizations compared to patients with other cancer types [ 2 ]. The disease and treatment trajectory of HMs is labile, with periods of inpatient hospitalization and outpatient care [ 3 , 4 , 5 ]. Patients commonly experience a wide range of physical symptoms, including fatigue and pain. Additionally, patients are often immunocompromised and at risk for life threatening infections. Alongside these physical concerns, patients face psychological challenges such as anxiety, depression, distress, and fear of recurrence [ 6 , 7 ]. Moreover, intensive treatment commonly leads to diminished ability to perform daily living activities, increasing HM patients' reliance on others for support [ 6 , 7 , 8 ]. Understanding the psychosocial costs of cancer during treatment is essential to delivering quality patient centered care [ 9 ]. The demanding treatment journey for HMs involves managing complex care regimens, prolonged hospital stays, home care, frequent emergency department visits, and severe side effects; this can place significant burden on family caregivers [ 10 ]. Caregivers provide unpaid logistical and emotional support to patients while simultaneously experiencing emotional distress associated with their loved ones' illness [ 11 ]. Caregiving for a patient with HM often requires caregivers to deliver care at home, help with treatment decisions, manage healthcare [ 12 ], and provide financial support [ 13 ]. These caregiving demands can negatively affect caregivers' physical health, quality of life, and emotional well‐being [ 14 , 15 ], and can compromise the care and support they can provide to the patient with HM [ 15 ]. Given the physical and psychological challenges associated with symptom burden and treatment, this qualitative study explores the social and psychological impact of HM. Patients' and caregivers' relationships with the healthcare system and providers are also explored, considering how healthcare providers and interactions with the healthcare system may alleviate or exacerbate stress during this time [ 16 ]. Previous research has identified the initial inpatient hospitalization phase for patients with HM as a period marked by unique stressors and risk to patients' quality of life [ 8 ], and patients' psychosocial challenges may shift as patients progress through the treatment period [ 17 ]. Similarly, caregivers' needs may evolve as patients increasingly rely on them following the initial inpatient hospitalization [ 18 ]. Therefore, this study aims to examine the impacts of HM on both patients and caregivers following the period of diagnosis and initial treatment. 2. Method 2.1. Study Design This study utilized a qualitative descriptive design [ 19 ] to explore the experiences of patients diagnosed with HM and their caregivers. Data were collected as part of a larger longitudinal mixed‐methods study. Time 1 data were collected within 3 months of diagnosis ( M = 2.65 weeks) and are reported elsewhere [ 20 , 21 , 22 ]. The current study analyzed data cross‐sectionally at Time 2, approximately 8 weeks (± 2 weeks) after treatment initiation to capture families' adjustment once patients typically complete the first inpatient hospitalization period. We also retained three participants with later data collection timepoints (13–26 weeks) because these families were still in the acute treatment phase, and their experiences remained aligned with the study's focus on early psychosocial adjustment. 2.2. Sample and Setting A convenience sample of patients with HM ( n = 24) and their caregivers ( n = 24) were recruited from an inpatient oncology unit at a National Cancer Institute–designated cancer center in the mid‐Atlantic region of the United States. Eligible patients were adults (ages 18 or older), within three months of their HM diagnosis, currently undergoing treatment for their HM at the inpatient oncology unit, and able to identify an unpaid, adult caregiver to invite into the study. Any patient with HM, regardless of subtype, was included in this study due to similarities in the treatment course across all HMs. All participants were able to read, write, and speak English. Informed consent was obtained from all participants, and the study was approved by the institutional review boards of both the cancer center and affiliated university. Of the 42 patients approached for recruitment, one declined and 13 had caregivers who declined. By Time 2, three dyads were lost due to patient death or illness severity, leaving 25 patient–caregiver dyads. Among the 25 patient‐caregiver dyads, one caregiver and one patient did not participate in Time 2 interviews, resulting in a final sample of 24 patients and 24 caregivers. 2.3. Data Collection Data was collected through semi‐structured interviews and demographic surveys. Informed by the Cancer Family Caregiving Experience Framework [ 23 ], the interview questions were developed by the fifth author (a woman with a doctorate in her field) and included open‐ended questions for patients with HM and caregivers on coping, emotional well‐being, and challenges faced during diagnosis and treatment. Interview questions were modified during data collection for increased clarity and alignment with study aims. Interviews were conducted by three psychology doctoral students and one microbiology/immunology graduate student either in private spaces within the cancer center or over the phone for participant convenience. Interviews lasted between 15 and 50 min and were audio‐recorded and transcribed verbatim. Each participant was compensated with a $25 gift card per interview. Data were reviewed during collection to monitor for saturation, and the final sample met recommended minimums for data saturation [ 24 ]. 2.4. Data Analysis Deidentified data (i.e., interview transcripts) were uploaded to an internal university‐secured GoogleDrive and analyzed using GoogleDocs and GoogleSheets. A content analysis [ 25 ] was employed to systematically code and categorize qualitative data, identify contextual patterns, and describe both the frequency and meaning of ideas. A line‐by‐line coding approach was used to identify preliminary codes, which were double‐coded to ensure consistency and trustworthiness. Codes were then categorized into themes and quantified by the frequency of occurrence. A comprehensive codebook detailing codes, definitions, and examples of themes, was developed at Time 1 and refined iteratively at Time 2. Additions, subtractions, and changes to codes and themes were made based on responses at Time 2. The team maintained a detailed audit trail documenting coding decisions and theme development. These strategies were implemented to maintain the scientific integrity and trustworthiness of the study's findings. We followed the consolidated criteria for reporting qualitative research (COREQ), an evidence‐based, 32‐item checklist [ 26 ]. 3. Results Demographic information is reported in Table 1 and themes are summarized in Table 2 . TABLE 1. Sample Demographics . Patients Family Caregivers Variable M (SD) or N (%) M (SD) or N (%) Age in years 52.8 (16.4) 56.4 (14.4) Gender Male 13 (54.2%) 7 (29.2%) Female 11 (45.8%) 17 (70.8%) Race and Ethnicity Black or African American 4 (16.7%) 3 (12.5%) Caucasian 17 (70.8%) 19 (79.2%) Other (specified multiracial) 2 (8.3%) 1 (4.2%) Missing 1 (4.2%) 1 (4.2%) Annual household income in USD < 25,000 7 (29.2%) 1 (4.2%) 25,000–45,000 2 (8.3%) 4 (16.7%) 45,000–65,000 6 (25.0%) 8 (33.3%) 65,000–85,000 2 (8.3%) 1 (4.2%) 85,000–105,000 1 (4.2%) 2 (8.3%) > 105,000 6 (25.0%) 5 (20.8%) Missing 0 (0.0%) 3 (12.5%) Marital status Single 4 (16.7%) 2 (8.3%) Married 14 (58.3%) 17 (70.8%) Divorced 5 (20.8%) 3 (12.5%) Widowed 1 (4.2%) 2 (8.3%) Employment status Full‐time 8 (33.3%) 8 (33.3%) Unemployed 1 (4.2%) 3 (12.5%) Medical leave 3 (12.5%) 0 (0.0%) Retired 7 (29.2%) 10 (41.7%) Disability 5 (20.8%) 0 (0.0%) Part‐time 0 (0.0%) 2 (8.3%) Missing 0 (0.0%) 1 (4.2%) Education Some high school 1 (4.2%) 0 (0.0%) High school graduate/GED 4 (16.7%) 6 (25.0%) Some college 5 (20.8%) 6 (25.0%) College graduate‐Associates 4 (16.7%) 2 (8.3%) Graduate trade 1 (4.2%) 1 (4.2%) College graduate‐Bachelors 4 (16.7%) 4 (16.7%) Graduate degree 5 (20.8%) 3 (12.5%) Post graduate 0 (0.0%) 2 (8.3%) Diagnosis Acute myeloid leukemia 12 (50.0%) NA Acute lymphoblastic leukemia 6 (25.0%) NA Non‐Hodgkin lymphoma 3 (12.5%) NA Acute promyelocytic leukemia 1 (4.2%) NA Missing 2 (8.3%) NA Relationship to Patient Spouse/Significant other NA 15 (62.5%) Parent NA 3 (12.5%) Child NA 3 (12.5%) Other NA 3 (12.5%) Open in a new tab Abbreviations: GED = General Educational Development; M = mean; SD = standard deviation. TABLE 2. Description of themes. Theme and description Total ( N = 48) Patients ( N = 24) Caregivers ( N = 24) Logistical impact Challenges due to frequency of appointments (i.e., finding transportation, time spent commuting, fulfilling other responsibilities) 18 7 11 Financial impact Challenges due to uncertainty and burden associated with medical costs. Families relied on strategies (e.g., cutting costs) and external resources (e.g., social security) to manage costs. 15 7 8 Emotional impact Patients' emotional distress due to the physical impact of their illness and treatment (e.g., fatigue), as well as social, logistical, and financial hardships associated with cancer (e.g., isolation from loved ones). Caregivers' emotional distress due to care responsibilities and concern for the patients' health. Improved emotional well‐being compared to earlier in treatment. 39 18 21 Physical impact Patient challenges due to physical symptoms of disease and treatment and subsequent disruption to normal activities. Variability in physical challenges depending on treatment, with some patients noting improved physical functioning. Caregiver challenges due to physical toll of caregiving (i.e., decreased energy, neglect of self‐care, and physiological stress) 38 24 14 Relationship with healthcare system and providers Support from healthcare providers (e.g., good communication, healthcare team coordination) led to satisfaction and trust in good care. Challenges posed by lack of information for caregivers, provider communication, and hospitalization‐related discomfort. 44 20 24 Open in a new tab Note: N reflects the frequency of occurrence for each theme, based on participants' responses to open‐ended questions during semi‐structured interviews. 3.1. Logistical Impact Patients with HM ( n = 7) and caregivers ( n = 11) described logistical challenges of treatment. Patients and caregivers explained that unanticipated changes to the patient's treatment schedule and the time required for care was disruptive to daily routines, work schedules, and planning for future events. Specific challenges included frequency of outpatient treatments, finding reliable and consistent transportation to medical appointments, the length of time needed to attend appointments, and the burden these challenges imposed on the caregiver. These challenges were especially taxing for families living far from the hospital, such as those in rural areas who had to travel to the city. To lessen the burden, one caregiver described seeking local care to eliminate the need to travel to another city. Any day that I have to take him anywhere means that whole day is gone and that typically is anywhere from 2 to 5 days a week. Caregiver 138 I can leave the hotel, go [to hospital for treatment], and then go back to work. I didn’t anticipate the hour and fifteen‐minutes’ drive up, hour and fifteen‐minutes’ drive back. I didn’t anticipate the additional time involved in that Monday through Friday. I’m still [dealing] with how to make it all work. Patient 132 3.2. Financial Impact Patients ( n = 7) and caregivers ( n = 8) reported financial concerns including uncertainty about the costs of medical services prior to billing, which services and medications were covered by co‐pays, whether services and medications uncovered by co‐pays would be reimbursed by insurance, and which services were considered in‐ or out‐of‐network. One patient reported intentions to set up a payment plan with the hospital and, if that failed, to declare bankruptcy. Another reported not responding to payment requests because they did not know how they would pay. Patients and caregivers also described difficulties accessing prescribed medications due to high co‐pays or lack of insurance coverage, which rendered these medications unaffordable. We have never seen a bill and do not know what to expect. You don’t know what the insurance is going to do and what you’re going to be left with. Caregiver 119 Patients and caregivers who had already experienced the financial consequences associated with care adjusted their finance strategies by relying on savings, reducing spending, and selling belongings. Caregivers described taking on new responsibilities due to financial strain and the patient's loss of income, such as managing household bills and assuming the role of primary earner, even when their own income was insufficient to fully compensate for the loss. Some families relied on external financial resources, including workplace support, social security, disability coverage, hospital grants, and charitable organizations. These supports relieved financial stress for some, while others continued to struggle. Patients noted that public assistance programs were difficult to navigate, making the process frustrating and time consuming, particularly when their capacity to manage such tasks was limited. One caregiver described the assistance from charity funding as insufficient to cover their expenses. We applied and were approved for emergency food stamps, so that helped a little bit. I have to start selling off stuff. Patient 123 3.3. Emotional Impact Patients ( n = 18) expressed feeling depressed, anxious, and frustrated about hardships including financial concerns, logistical challenges with receiving care, physical discomfort, and isolation from their family and friends. Patients reported the emotional challenges due to making treatment decisions (e.g., whether to have a transplant), weighing the risks of these treatments, and managing feelings of guilt about the caregiving burden and emotional toll their illness placed on their family. Patients also reported stress‐related difficulties with concentration, including forgetfulness and difficulties planning ahead. I get really bored and I start getting real anxious like [I] just want to get out of here. Waiting on the lab results like, ‘did we get any better, did we get any worse?’. Patient 125 Caregivers ( n = 21) described feeling stressed, overwhelmed, and frustrated by the extensive responsibilities of caregiving, including driving patients to the hospital, managing finances and appointments, and providing ongoing emotional support. Many reported that the emotional and cognitive demands of caregiving (e.g., worrying about the patient's condition) made it difficult to concentrate, engage in self‐care, spend time with family and friends, or focus on work. Several noted becoming more emotionally sensitive or crying more often. Just feeling very overwhelmed. It’s just a to‐do list all the time and never getting it all the way done. But I just pick up where I left off the day before. I gotta make this phone call or I gotta get him to this doctor appointment or do this or do that. Caregiver 139 Caregivers also expressed distress stemming from their limited ability to help the patient and from fears about prognostic uncertainties (e.g., transplant eligibility, variable platelet counts, hospital readmissions), the possibility of death, and the physical and emotional toll of treatment on the patient (e.g., changes in appearance or temperament). Logistical challenges, such as frequent commutes, prolonged stays at the hospital, and frustrations with navigating the healthcare system, were also described as significant stressors. How difficult it would be to see your husband lose so much weight and not be able to walk, not be able to hardly talk. I was not prepared to see it that bad. I was not prepared for that. It was very devastating to see that with somebody you love. Caregiver 126 In addition, some caregivers discussed feelings of burden and interpersonal stress from being heavily relied upon by the patient. A few described conflict with the patient, such as resistance to attending appointments or being irritable with the caregiver. Others reflected on stress related to meeting caregiving demands while maintaining their employment, as well as feeling selfish about wanting personal time. One caregiver shared anxiety about who would care for the patient if the caregiver became ill. She always depends on everybody to help her and do for her. She doesn’t take the initiative to try to do things for herself sometimes, and it can be frustrating. Caregiver 116 Some patients and caregivers described feeling relief, particularly in retrospect compared to the time of diagnosis, noting positive progress with treatment, a sense of normalcy after returning home from the hospital, and increased familiarity with the treatment process. I adapted more quickly than I thought I would. I had future anxiety about how to handle situations. All that was my brain being anxious and it actually worked out fairly well. Caregiver 126 3.4. Physical Impact Patients ( n = 24) talked about the physical impact of the disease, including difficulties sleeping, walking, poor concentration, fatigue, reduced appetite, weight loss, hair loss, pain, and physical discomfort due to cancer symptoms and treatment, particularly side effects of chemotherapy and prescribed medications. Patients reported challenges in mobility, including needing to practice walking or engage in physical therapy to rebuild strength. Patients also noted daily expected and unexpected fluctuations in their physical well‐being, citing their treatments as underlying this variability. These symptoms impacted their energy and limited their ability to participate in social activities, hobbies, and responsibilities. Like going into treatment or the hospital this last time, I felt fine, probably the best I’ve felt in a long time, but give it a couple days and I’ll be feeling like garbage. Patient 128 Patients and caregivers retroactively reported patient symptom relief and feelings of empowerment, reflecting on current symptoms compared to earlier points in treatment. I can take deep breaths now, I’ve lost most of the shakes I’ve had, I have strength in my legs. In fact, I can walk all over the house with my rollator. Patient 119 Caregivers ( n = 14) described the toll prolonged caregiving took on their physical health, reporting fatigue and limited energy to attend to their own physical needs, such as making meals or getting sufficient sleep. The physical impact for caregivers fluctuated with the patient's treatment trajectory. For example, caregivers reported eating or sleeping poorly when the patient required hospitalization treatment. One caregiver described that after spending a long time in the hospital with the patient, they were more likely to pick up food than make meals at home, while another described postponing their own medical care to prioritize caregiving responsibilities. Caregivers also attributed physiological symptoms to the stress of caregiving, such as nausea and difficulty sleeping. One caregiver made intentional changes, such as prioritizing sufficient sleep, to maintain their own health so they had the strength to continue to provide care. I’m so tired even though I do get some sleep, I still wake up tired I guess thinking about the day ahead of me. Caregiver 139 3.5. Relationship With the Healthcare System and Providers Patients ( n = 11) and caregivers ( n = 8) reflected on positive experiences they had with the healthcare system and providers. Patients noted that providers were kind and provided helpful information regarding their diagnosis, such as the future of treatment expectations and side effects (e.g., hair loss) and appreciated that their healthcare team coordinated with one another to provide integrated care. One patient found comfort in routine check‐ins from the healthcare team, while another expressed optimism when their healthcare team showed confidence in their treatment. Patients expressed satisfaction and gratitude for the care and reflected that they trusted their healthcare team to continue providing good care in upcoming phases of treatment. Caregivers appreciated it when the healthcare team provided assistance navigating logistical aspects of care (e.g., insurance claims, referrals, local care, disability services, acquiring transportation), including making calls to acquire services and gathering appropriate documentation. Caregivers expressed appreciation, satisfaction in care, and trust when the healthcare team communicated with them about the patient's illness and prepared them for caregiving tasks by answering questions or explaining how to provide care. I’m not really, super worried about it, I just take it according to what my doctor [says], his course of action because he’s been so good for so many years. Patient 124 Some patients ( n = 3) and caregivers ( n = 14) reported stressful interactions with the healthcare system over the course of outpatient treatments, centering on communication challenges, long wait times, and logistical barriers. Both patients and caregivers reported frustrations communicating with the healthcare team as well as communication challenges within the team itself. Patients described feeling that the healthcare team made treatment decisions without fully informing them, leading to a sense of exclusion and distrust. Caregivers similarly reported difficulties communicating with providers, including feeling dismissed when raising concerns and misunderstanding information about the patient's treatment progress. I don’t think [the healthcare team] tell us everything they know. The next time they talk to you, you doubt what they’re saying. Caregiver 134 Patients and caregivers highlighted challenges stemming from system‐level issues, such as long wait times caused by last‐minute changes in treatment plans or administrative errors. Some caregivers felt that the healthcare team was not adequately informed about the patient's treatment history, which contributed to tension and conflict. Others described the burden of navigating hospital‐provided resources while also managing day‐to‐day caregiving demands. One caregiver emphasized the importance of including caregivers in decision‐making, particularly when the patient was in too much pain to advocate for themselves. Caregivers reported that they would have benefited from more information on the diagnosis and treatment impact on patients, as well as instructions for how to care for patients outside of the hospital. Some stated that a formal course or program would be especially helpful. If they had a program that would prepare you a little bit more for what we’re gonna do, this is what we’ll have to do, this is the type of cancer, your hair is gonna fall out, you’re gonna lose weight, that kinda thing. Caregiver 122 Patients ( n = 8) and caregivers ( n = 6) reported on the impact of hospitalization, discussing challenges with reliable hospital food quality and delivery, boredom, not being able to go outside, and disrupted sleep due to uncomfortable beds and overnight vital checks by the healthcare team. One patient was surprised by the frequency of overnight vitals checks, describing them as unexpected, particularly when they did not know the healthcare team had rotated. At the hospital, they’re constantly checking and taking labs, but at home, [sleep] is not a problem. Patient 128 Patients in inpatient care appreciated being permitted to walk around the hospital to ease the boredom of prolonged confinement to their hospital room. Those who transitioned to outpatient care valued their home environment, citing improved sleep, increased freedom, access to better food, and time spent outside. Being in a hospital for two months is very difficult. Just being outside is so nice. I never got to go outside one time. I hate to compare it to prison because it’s nothing like prison, but it almost is because you have a room and you stay there. Patient 105 4. Discussion The qualitative findings illustrate the psychosocial impact on patients and caregivers following the initial months of acute treatment for a HM. These findings are consistent with previous research demonstrating a variety of barriers to optimal cancer care and well‐being in this population [ 13 ]. Because much of the existing research in this area has relied on small samples, the convergence between our results and prior findings provides valuable support for the developing evidence base. Additionally, this work contributes an integrated understanding of patients' and caregivers' psychosocial needs during this early treatment phase. By examining both patient and caregiver perspectives within the same study, this work illuminates shared challenges and differences in their experiences. Findings illustrated practical challenges following a HM diagnosis. While patients and caregivers worry about patient loneliness during hospitalization in the first three months of treatment [ 20 ], current findings reflect families' concerns during the transition to outpatient care, including transporting patients to outpatient visits and the significant disruptions to the work and lifestyles of both caregivers and patients. Previous work has shown that caregivers must juggle multiple responsibilities to provide care to the patient [ 13 ]. Our findings suggest that the time required to take the patient to appointments meaningfully contributes to caregivers' workload. Whereas previous research suggests families worry about financial implications closer to diagnosis [ 20 ], the current study suggests families experience actualized financial strain in the following months of treatment, with some making significant lifestyle changes to address financial concerns. These results align with previous research, such that concerns about treatment costs result in caregivers making decisions to cover expenses that significantly impact their daily lives [ 13 , 27 ]. The present findings extend this body of knowledge by highlighting the specific financial uncertainties families face. Patients with HM and their caregivers reported challenges related to unknown financial demands and financial relief. Regardless of actual financial strain, the barriers to knowing outcomes such as treatment cost or insurance coverage may be a significant source of stress. Prior research demonstrates that patients and caregivers experience worry and distress related to the unpredictability of the illness trajectory [ 28 ], and financial uncertainties may compound these worries. Patients and caregivers most frequently discussed the physical and emotional challenges of the disease. These concerns were similar to the concerns of patients and caregivers within 3 months of diagnosis [ 20 ], including fatigue, discomfort, and psychosocial distress. The majority of caregivers endorsed emotional and physical burdens of caregiving, including negative impacts on their sleep, eating, and physiological stress symptoms. These results align with past research showing caregiving is associated with perceived deterioration in health [ 14 ]. While patients also reported physical and emotional challenges, findings demonstrated that some patients experienced relief as they progressed in treatment, including improved physical strength and sleep after transitioning to outpatient care. These narratives align with quantitative research demonstrating that while patients experience poorer quality of life immediately following diagnosis, quality of life may improve over the course of the acute treatment phase [ 8 ]. Narratives from this study highlight the benefits of returning home for patients who transitioned to outpatient care. While research indicates that both patients and caregivers experience many stressors related to their interactions with the healthcare system immediately following diagnosis [ 7 , 20 ], few patients reported difficulties with the healthcare system in the current study. However, more than half of caregivers described challenges in this area. At this point in treatment, caregivers may take on the primary role of managing their family member's care. Caregiver narratives align with work demonstrating caregivers often feel unprepared to provide care for the patient when they return home from hospitalization and lack informational resources to understand the patient's illness [ 18 ]. While other research has described caregiver challenges in gathering information [ 13 ], findings from this study further emphasize that communication challenges may result in distrust toward the healthcare team, particularly for caregivers. Among patients, trust in the healthcare team has been linked to reduced worry and greater treatment adherence [ 29 ]; however, less is known about the implications of caregivers' trust in providers beyond care preparation. 4.1. Implications Findings support the need for interventions that address physical, emotional, logistical, and financial challenges for patients with HM and caregivers. Addressing practical challenges, along with providing psychological support, may help manage families' emotional strain and enhance overall well‐being [ 30 , 31 ]. Research suggests that offering palliative care services early in cancer treatment can improve physical and emotional outcomes [ 32 ]. Mitigating barriers to palliative care during the active treatment phase, such as misperceptions about the role of palliative care and need for more clinicians, may increase patients' physical and emotional well‐being and fill in gaps in informational needs [ 5 ]. Results demonstrated that some patients experienced improved emotional well‐being with time and familiarity with treatment. Studies that examine resilience in patients with HM may guide interventions by providing insight into why some patients improve over time while others continue to struggle [ 33 ]. Consistent with other qualitative research on financial interventions [ 34 ], results suggest families may be best supported by proactively addressing financial uncertainties early in treatment and assisting patients and caregivers with navigating barriers to attaining helpful resources. Approaches in which healthcare providers communicate directly with patients about anticipated costs and include strategies to manage financial strains in patient care plans have been proposed to help families manage the costs associated with cancer treatment [ 35 ]. Our findings also show that transportation barriers are burdensome for both caregivers and patients. Previous research has identified limitations to transportation assistance provided by healthcare systems [ 36 ], but more research on the prevalence and scope of these barriers is needed to support policy changes and widespread implementation of effective programs [ 37 ]. This study provides evidence that transportation is an unmet need and may guide future quantitative research that evaluates patients' social needs and risk factors for transportation insecurity. Results from this study also suggest that caregivers would benefit from programs that proactively support training and information delivery during the initial treatment stage. Although providers may communicate about the treatment trajectory and provide information to prepare family members for caregiving, families may be overwhelmed by the mass of information and the stress of supporting their loved one [ 38 ]. While programs designed to educate caregivers on patient care have successfully increased preparedness [ 39 ], most caregiving support offered by hospitals is not evidence‐based and does not include caregiver training [ 40 ]. Intervention research that balances mitigating caregiver psychosocial challenges with affordability and efficiency is needed to promote greater implementation of these programs. Our findings highlight factors that are important to caregivers, such as education on providing informal care, and interventions might focus on these relevant elements to maximize practicality. 4.2. Limitations Several limitations of this study should be acknowledged. Data collection ranged between 6‐ to 26‐week following treatment initiation, which may have contributed to heterogeneity in participants' treatment phase (e.g., inpatient or outpatient care) and subsequent differences in their support needs. Additionally, generalizability is limited by the use of convenience sampling from a single inpatient oncology unit and the relatively homogeneous study sample, which was predominantly White, married, and living with their partners. Since the sample included patients with varying hematological malignancies (e.g., AML, ALL, NHL), findings should be interpreted accordingly, as treatment experiences may differ across HM diagnoses. Future research can address these limitations by recruiting more diverse samples for studies with more frequent assessment points and longer follow‐up periods. 5. Conclusions This study illuminated ways in which families affected by HM perceive their healthcare, logistical, financial, physical, and emotional experiences. Results highlight long‐term challenges and the need for early interventions that provide families with education about the impact of the disease, training to increase caregiver preparation, and resources that decrease cumulative strains. Author Contributions Study design: Sydney Sumrall, Rebecca Hoppe, Tara Albrecht, Marcia Winter. Acquisition of data: Rebecca Hoppe, Tara Albrecht, Marcia Winter. Data analysis and interpretation, manuscript preparation, and manuscript review: Sydney Sumrall, Rebecca Hoppe, Julia Slack, Tara Albrecht, Youran Lee, Marcia Winter. Conflicts of Interest The authors declare no conflicts of interest. 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