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Hematopoietic Stem Cell Transplantation (HSCT) is a treatment option utilized for children and adolescents with malignant and nonmalignant diseases. Anxiety, uncertainty, and hope are commonly observed in those faced with this treatment decision. The purpose of this integrative review was to evaluate current literature on stakeholders’ perspectives on pursuing HSCT in children and adolescents with malignant or nonmalignant diseases. The aim is to review the literature specific to what influences those making the decision to proceed with HSCT as a treatment modality; thus, donors are not included as stakeholders.
Methods, Intervention, & Analysis
Using standard integrative review methods, we searched PubMed, CINAHL, and MEDLINE databases with the following search terms: hematopoietic stem cell transplantation, bone marrow transplantation, decision-making, attitude, and decision. Inclusion criteria consisted of research articles in the English language published in peer-reviewed journals over the last 10 years; and at least one of the following stakeholder’s perspectives: the pediatric patient, the parent and/or guardian, and/or the pediatric provider. We excluded case reports and articles pertaining only to adult patients or providers. Sixteen articles met the criteria. The articles were compared by disease type, stakeholder perspective, and methodology.
Findings & Interpretation
Stakeholders pursuing HSCT for a malignant disease often felt it was their only hope, while in a nonmalignant disease a multitude of medical and psychosocial factors were evident. Regardless of disease, all stakeholders described uncertainty. Patients and family members found provider opinion to be influential in their decision, but few studies considered provider perspectives. Experimental studies were lacking, as well as research of actual decision-making experiences.
Discussion & Implications
Additional research is necessary to better understand factors affecting the decision to pursue HSCT in children and adolescents. Experimental studies are essential to guide future decisional support and educational intervention in this population. Inclusion of provider perspectives and actual versus hypothetical decision-making experiences are also necessary in future studies.