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

BackgroundShared decision making is widely endorsed as the gold standard for patient-centered care, yet in the context of cancer, patients often describe surgery as a nonchoice. This narrative review explores the concept of patient-perceived nonchoice decision making in cancer surgery.MethodsThis narrative review was guided by the Scale for the Assessment of Narrative Review Articles (SANRA) criteria. Studies examining nonchoice surgical decision making in adult patients with resectable solid-organ malignancies were identified through manual screening, citation searching, and a targeted PubMed search. Descriptive themes were developed through inductive analysis and iterative discussions among authors. Findings were synthesized using a structured narrative approach.ResultsSeventeen studies met inclusion criteria. Three themes emerged: 1) surgery as the only choice offered by the surgeon, 2) choosing surgery did not feel like a choice, and (3) patient preference to relinquish decision making. According to patients, surgery was often framed as the sole viable treatment option with minimal discussion of alternatives. External social and societal pressures, combined with the belief that surgery equated to survival, further reinforced this perception. Patients who felt overwhelmed or had little medical knowledge often chose to relinquish decision-making responsibility. Collectively, these dynamics limited patients' ability to engage in meaningful deliberation.ConclusionsDespite the emphasis on shared decision making in cancer care, many patients undergoing surgery for resectable solid-organ malignancy face constrained decision making shaped by clinical realities, social context, and psychological stressors. Addressing the perception of surgery as a nonchoice is critical to promote meaningful patient engagement. Future research should aim to identify and mitigate modifiable factors that contribute to nonchoice mindsets, ultimately supporting value-concordant surgical decisions.HighlightsMany patients with cancer perceive surgery as their only option, rather than an active decision.Surgeons often frame surgery for cancer as inevitable, limiting discussions of alternatives and undermining shared decision making.Even when surgeons explicitly present surgical and nonsurgical options to patients, many patients still do not perceive a choice.Some patients intentionally defer decision making to surgeons, either out of trust in clinical expertise or a desire to avoid the emotional burden of choice.Understanding how nonchoice dynamics arise can help clinicians better support informed, values-based surgical decisions.