Shared decision-making about autologous stem cell transplantation: A qualitative study of older patients and physicians.

Abstract

Background: The decision-making process between autologous hematopoietic stem cell transplant (autoHSCT) and less-intensive treatments necessitates shared decision-making between older patients with hematological malignancies and healthcare providers. However, there is limited knowledge from both perspectives. This qualitative study aimed to comprehensively understand the experiences of shared decision-making regarding autoHSCT among older patients with hematological malignancies and physicians.

Methods: Older patients and physicians were recruited from the hematology department at one of the affiliated general hospitals of Wuhan University. They participated in semi-structured, in-depth face-to-face individual interviews from August 2022 to March 2023. The interviews explored their experiences with shared decision-making about autoHSCT. Interviews were transcribed verbatim and analyzed using Colaizzi's phenomenological method.

Results: Thirteen older patients and eight physicians were recruited. Two themes were identified: (1) Factors influencing AutoHSCT recommendations and decision-making: Seven factors were categorized into three groups: physician-driven factors (pretransplant assessments, experience-based judgment, and communication approaches), patient-driven factors (perceived benefits and risks, financial challenges, and family involvement), and mutual trust between patients and physicians, which is a bidirectional factor relying on both physicians' trust and the active participation of patients in the decision-making process. (2) Treatment planning and outcome expectations: Regardless of treatment choices, patients focused on engaging in self-management and prioritizing quality of life, and maintaining hope for positive outcomes.

Conclusions: The shared decision-making process for autoHSCT between older patients with hematological malignancies and physicians is shaped by physician-driven factors, patient-driven factors, and mutual trust. These findings provide a foundation for developing patient-centered care strategies, including decision aids and enhanced communication training for physicians, aimed at improving outcomes for older patients facing complex treatment choices. Future research should explore how these factors interact over time, through longitudinal studies, to assess their long-term impact on patient outcomes and quality of life.