Decision-Making in Pediatric Hematopoietic Stem Cell Transplantation: Perspectives of Physicians, Patients, and Families

Pediatric hematopoietic stem cell transplantation (HSCT) is a complex therapeutic procedure that presents significant ethical, clinical, and psychosocial challenges. Decision-making in this context involves multiple stakeholders, including physicians, patients, and families, and is influenced by several medical and non-medical factors. This narrative review provides a descriptive synthesis of the literature to analyze the factors influencing decision-making in pediatric HSCT and to explore the roles and perspectives of the different actors involved in this process. Relevant literature was identified through searches of electronic databases, including PubMed, Scopus, Embase, and Web of Science, including studies published up to March 2024. Gray literature was not systematically included. The findings highlight that clinical condition, availability and understanding of information, socioeconomic context, religious beliefs, and perception of risks and benefits significantly influence treatment decisions. In addition, the perspectives of patients, parents, and healthcare professionals play a critical role in shaping the decision-making process. Shared decision-making, clear communication, and adequate psychological support are essential elements to facilitate informed and ethically sound decisions. Understanding these dynamics is fundamental to improving patient-centered care in pediatric transplantation.