Nonchoice Surgical Decision Making among Patients with Cancer: A Narrative Review

Area of Science:

• Oncology
• Surgical Oncology
• Patient-Centered Care

Background:

• Shared decision-making is crucial for patient-centered cancer care.
• However, patients with cancer often perceive surgical options as non-negotiable.

Purpose of the Study:

• To explore the phenomenon of patient-perceived nonchoice decision-making in cancer surgery.
• To identify factors contributing to this perception.

Main Methods:

• A narrative review guided by SANRA criteria.
• Inclusion of studies on nonchoice surgical decision-making in adult patients with resectable solid-organ malignancies.
• Inductive analysis and structured narrative synthesis.

Main Results:

• Seventeen studies revealed three themes: surgery presented as the sole option, a lack of perceived choice, and patient relinquishment of decision-making.
• Patients perceived surgery as the only viable path due to framing by surgeons, social pressures, and survival beliefs.
• Overwhelmed patients or those with limited medical knowledge deferred decisions, hindering deliberation.

Conclusions:

• Despite shared decision-making ideals, cancer patients face constrained surgical choices due to clinical, social, and psychological factors.
• Addressing the perception of surgery as a nonchoice is vital for meaningful patient engagement.
• Future research should mitigate factors contributing to nonchoice mindsets for value-concordant decisions.