Exploring Relational Autonomy of Vietnamese Patients' Experiences in Decision-Making Regarding Hematopoietic Stem Cell Transplantation: A Qualitative Interview Study

Abstract

Background: Hematopoietic stem cell transplantation (HSCT) decisions for patients with hematologic malignancies are deeply intertwined with trust, doctor-patient communication, and interaction with family. Relational autonomy highlights how social relationships and cultural contexts influence patients' decisions, offering a crucial lens to understand this complex process.

Aims: To understand the decision-making experience of adult patients with hematologic malignancies in Vietnam regarding HSCT through the lens of relational autonomy.

Methods: Convenient and snowball sampling interviewed 22 adult patients diagnosed with hematologic malignancies who had accepted or refused HSCT. Online semi-structured interviews were conducted in Vietnam. Content analysis was applied to identify themes.

Results: Three themes emerged: "coming to identify as a patient," "experiencing the influence of relational networks," and "hoping one's voice will be heard." Trust and communication with healthcare professionals, relationships with family members, and broader social networks were found to critically shape the decision-making process. Patients initiated their consideration of HSCT within a Vietnamese cultural framework while integrating external influences. Social networks profoundly affect patient autonomy, as patients continuously reflected on their views and engaged with others to maintain their final say in decisions. Participants' interpretation of their significant other's experiences supported and maintained their autonomy.

Conclusions: The HSCT decision-making process is shaped by the interplay of patients' personal experiences, trust, socio-cultural relationships, and surrounding support systems. Relational autonomy offers key insights into how patients use social networks and cultural backgrounds to navigate their treatment choices, emphasizing the importance of supportive environments that empower patients to make informed and autonomous decisions.

Keywords: HSCT; blood cancer; doctor‐patient communication; hematologic malignancies; hematopoietic stem cell transplantation; oncology decision‐making; relational autonomy; trust.