Academic Journal
Nonchoice Surgical Decision Making among Patients with Cancer: A Narrative Review.
| Τίτλος: | Nonchoice Surgical Decision Making among Patients with Cancer: A Narrative Review. |
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| Συγγραφείς: | Bechthold AC; School of Nursing, University of Alabama at Birmingham, Birmingham, AL, USA., Kennedy A; Edward Via College of Osteopathic Medicine, Auburn, AL, USA., Monton O; Department of Surgery, McMaster University, Hamilton, ON, Canada., Kopecky KE; Department of Surgery, University of Alabama at Birmingham, Birmingham, AL, USA. |
| Πηγή: | Medical decision making : an international journal of the Society for Medical Decision Making [Med Decis Making] 2026 Aug; Vol. 46 (6), pp. 678-695. Date of Electronic Publication: 2026 Mar 19. |
| Τύπος έκδοσης: | Journal Article; Review |
| Γλώσσα: | English |
| Στοιχεία περιοδικού: | Publisher: Sage Publications Country of Publication: United States NLM ID: 8109073 Publication Model: Print-Electronic Cited Medium: Internet ISSN: 1552-681X (Electronic) Linking ISSN: 0272989X NLM ISO Abbreviation: Med Decis Making Subsets: MEDLINE |
| Imprint Name(s): | Publication: <2001->: Thousand Oaks, CA : Sage Publications Original Publication: Cambridge, MA : Birkhäuser, c1981- |
| Ιατρικοί όροι (MeSH): | Neoplasms*/surgery , Neoplasms*/psychology , Decision Making*, Patient Preference/psychology ; Patient Participation/psychology ; Humans ; Patient-Centered Care ; Choice Behavior ; Physician-Patient Relations ; Decision Making, Shared |
| Περίληψη: | 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. |
| Competing Interests: | The authors declared no potential conflicts of interest with respect to the research, authorship, and/or publication of this article. The authors disclosed receipt of the following financial support for the research, authorship, and/or publication of this article: Financial support for this study was not provided; however, Kimberly Kopecky, MD, MSCI, is funded by the UAB O’Neal Cancer Center, the Society for Surgical Oncology, and the American College of Surgeons for work related to patient and caregiver expectations. Funded by the University of Alabama at Birmingham Center for Palliative and Supportive Care PREP grant. |
| Contributed Indexing: | Keywords: choice; options; shared decision-making; surgery; surgical decision-making |
| Entry Date(s): | Date Created: 20260319 Date Completed: 20260709 Latest Revision: 20260709 |
| Update Code: | 20260709 |
| DOI: | 10.1177/0272989X261427003 |
| PMID: | 41854025 |
| Βάση Δεδομένων: | MEDLINE |
| ISSN: | 1552-681X |
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| DOI: | 10.1177/0272989X261427003 |