From consultation to choice: gynecologic cancer patients’ perspectives on shared decision making in clinical practice – findings from a cross-sectional observational qualitative interview study

Shared decision making (SDM) is a cornerstone of patient-centered care in oncology, yet its implementation remains inconsistent across clinical contexts. Particularly in gynecologic oncology, where treatment choices often carry profound implications for identity, fertility and quality of life, understanding how patients engage in SDM is crucial. Patient autonomy, understood as the capacity and right to participate meaningfully in medical decisions, is central to this process, yet remains complex and context-dependent. This study explores how women with gynecologic cancers experience decision making processes throughout the course of their treatment, with a focus on how their preferences, needs, and autonomy evolve over time. We conducted a qualitative, single-center, cross-sectional observational study using grounded theory methodology. Semi-structured interviews were held once with 20 female patients undergoing treatment for various gynecologic malignancies at a university medical center. Interviews explored experiences across treatment phases initiation, maintenance, pending/abstention and anticipated decisions. Participants expressed a wide range of attitudes toward decision making, shaped by emotional readiness, trust in clinicians, and interpersonal support. Early in treatment, many preferred clinician-led guidance due to emotional overload. Over time, some sought greater involvement, while others continued to delegate decisions. A minority of participants addressed treatment refusal or end-of-life decisions during interviews, often with ambivalence. Structural issues such as fragmented communication and lack of care continuity were cited as barriers to meaningful participation. Patients’ preferences for involvement in decision making are dynamic and context dependent. Our findings support models of relational and temporal autonomy and highlight the importance of responsive communication, trust, and systemic support in fostering ethical and effective SDM.These insights call for enhanced clinician training and organizational strategies to integrate SDM meaningfully into routine cancer care.