The perceptions of hematopoietic stem cell transplantation decision-making in patients with hematologic malignancies: a qualitative systematic review

PURPOSE: Hematopoietic stem cell transplantation (HSCT) remains the primary curative option for many hematologic malignancies, yet its substantial risks make the treatment decision highly complex and high stakes for patients. Although current qualitative studies have explored how patients perceive HSCT, a comprehensive synthesis of these insights is still lacking. This study synthesizes existing research on patient perceptions of HSCT to guide shared decision-making in clinical practice. METHODS: A literature search was conducted across eight databases: PubMed, CINAHL, PsycARTICLES, Web of Science, Embase, the Cochrane Library, Scopus, and ProQuest Dissertations & Theses Global, spanning from their respective inceptions to February 2026. The Joanna Briggs Institute criteria for qualitative research were utilized to evaluate the quality of the studies, and a content analysis approach was employed to integrate the findings. RESULTS: A total of 20 studies were included, yielding 4 new integrated findings: (1) constrained choices; (2) decision-making embedded in relational contexts; (3) the hidden toll: financial constraints and logistical hurdles; (4) concerns about restricted social participation and threats to identity caused by transplantation. CONCLUSION: HSCT decision-making is shaped not only by clinical risks and benefits, but also by constrained choice, relational contexts, practical circumstances, and concerns about future life. SDM-based decision support should therefore extend beyond information provision to clarify patients' understanding of the decision space, identify factors that constrain choice, and address the values and longer-term concerns that matter to them.