title: A study of factors influencing patients' decisions to undergo bone marrow transplantation from a sibling or matched related donor.
abstract: This study provides a theoretical analysis of factors influencing patients' decisions to undergo bone marrow transplantation. Data were gathered using single, unstructured interviews with seven bone marrow transplant candidates, and analysed in accordance with grounded theory methodology. Six theoretical categories were generated from the data. These were: the logical mind, gut instinct, personal aims, hope, preparing for transplant and trust in professionals. The findings are discussed in relation to theoretical literature and other research. The results of the study suggest that providing clinical or statistical information about transplantation may not, in itself, constitute adequate decision support. The adoption of a predominantly one-way process, whereby health-care professionals inform and educate patients, may fail to elicit broader subjective and contextual issues that influence patients' decisions. Patients may not fully consider treatment risks, or may interpret treatment information in idiosyncratic ways. Professionals may not foster adequate appreciation of risks, or may inadvertently frame information in ways that render some treatment options more acceptable than others. Recommendations focus upon: increasing professionals' awareness of the complex issues that may underpin patients' decisions, broader assessment of patients' understanding of decision situations, and tailoring information to meet the needs of individual patients.
authors.affiliation: Clinical Haematology, Ward 5E, John Radcliffe Hospital, Headington, Oxford OX3 9DU, UK.
authors.forename: L
authors.initials: L
authors.lastname: Bywater
authors.forename: S
authors.initials: S
authors.lastname: Atkins