Phased Traumatic Stress Responses Among Caregivers of Children and Adults Recently Diagnosed with Acute Leukemia: A Grounded Theory Study.

A diagnosis of acute leukemia (AL) represents a sudden, life-threatening event that places family caregivers (FCs) at high risk for traumatic stress. While traumatic stress symptoms have been documented among FCs later in the cancer trajectory, little is known about how these responses unfold during the immediate peri-diagnostic period, when acute stress disorder (ASD) may emerge, and early intervention could be most impactful. We conducted a qualitative study using a constructivist grounded theory approach to examine early traumatic stress responses among FCs of adults and children with newly diagnosed AL. Semi-structured interviews were conducted with 18 caregivers within the first six months of diagnosis as part of two clinical trials at major cancer centres in Toronto, Canada, and were analyzed iteratively using constant comparative methods. Caregivers described a coherent trajectory of traumatic stress responses across three phases. The anticipatory phase was characterized by prolonged uncertainty, helplessness, and mounting fear during diagnostic investigations. The acute phase, beginning at diagnosis, involved an abrupt shift toward emotional numbing, deliberate avoidance of catastrophic thoughts, and a narrowed focus on immediate tasks, often described as operating on "autopilot." In the post-acute phase, as patients stabilized and discharge approached, caregivers reported increased emotional access, including grief, anger, and recognition of their own trauma, alongside emerging concerns about long-term caregiving and life disruption. These findings suggest that FCs of individuals with newly diagnosed AL exhibit a phased pattern of traumatic stress responses, marked by an early, adaptive dissociative coping response followed by delayed emotional processing, underscoring the importance of phase-sensitive psychosocial care in oncology.