Healthcare professionals' perceptions of decision-making for older patients with cancer receiving systemic therapy: A systematic review and qualitative evidence synthesis

Decision-making about systemic therapy in older adults with cancer is complex due to frailty, clinical uncertainty, and competing treatment goals. Limited evidence exists synthesizing how healthcare professionals support decision-making in geriatric oncology. This qualitative systematic review searched four databases through November 2025 and conducted citation tracking. Thematic synthesis was performed, and confidence in findings was assessed using GRADE-CERQual (Confidence in the Evidence from Reviews of Qualitative research). Twelve studies involving 212 healthcare professionals were included. Two analytical and six descriptive themes were identified. Healthcare professionals sought to minimize treatment-related harm while respecting patients' values and life perspectives. Decision-making was shaped by clinical judgment integrating geriatric assessment findings, healthcare professionals' perspectives, ethical considerations regarding beneficence and autonomy, and structural factors such as resource limitations and interprofessional collaboration. These findings highlight the need for clinical expertise, collaboration across oncology, primary care, and geriatric care providers, and system-level support for geriatric-informed care.