The illusion of choice. Decision-making in the context of advanced cancer

Abstract

Patients with advanced cancer often face difficult and impactful decisions. When cure is no longer possible, palliative care begins. However, palliative care for these patients is often not sufficiently personalized. Conversations about wishes and goals usually start too late—often in the final stage of life—and are limited in scope. There is also a strong focus on life-prolonging treatments, with little attention to the patient’s personal context. This can create an “illusion of choice”: patients have options, but do not always experience them as real choices. Using a method called the double surprise question, doctors can identify earlier which patients may benefit from palliative care. Discussions about what truly matters to patients should happen earlier and more often. Improved communication skills and collaboration between general practitioners and specialists are essential, ensuring that patients can make choices that genuinely fit their lives and values.