Bidirectional association between irritability and executive function in youth from late childhood to early adolescence: Between- and within-person effects.

A cancer diagnosis can lead to severe psychological distress. Approximately one-third of all patients in acute care meet criteria for at least one mental disorder [–]. For patients with advanced cancer, prevalence rates are even higher, reaching up to 50% [, ]. Symptoms of anxiety and depression as well as uncertainty and loss of control may impair patients’ ability to process complex information and to actively participate in clinical decision-making [–]. At the same time, patients with advanced cancer are confronted with complex and far-reaching treatment decisions that often carry profound implications for quality of life, symptom burden, and remaining lifetime. In contrast to earlier stages of the disease, therapeutic options in palliative care are commonly associated with limited prognostic benefit and uncertain outcomes, particularly with respect to survival and quality-of-life outcomes [, ]. Treatment decisions therefore often involve weighing potential benefits against substantial burdens, such as treatment-related side effects or reduced physical or psychosocial functioning. Shared decision-making (SDM) provides a conceptual framework for such preference-sensitive decisions by emphasizing a collaborative process in which clinicians and patients exchange information, discuss available options, and integrate clinical evidence with patients’ values, goals, and preferences [, ]. SDM has been conceptualized as a collaborative process that differs from both paternalistic decision-making and informed decision-making. Contemporary models further emphasize its iterative and flexible nature, including clear invitations to participate, support in understanding options, elicitation of patients’ goals and preferences, and adaptation to patients’ vulnerability, health literacy, emotional readiness, and desired level of involvement [–]. However, treatment decisions frequently occur within time-constrained clinical encounters and under emotionally demanding circumstances, which may limit opportunities for shared decision-making processes []. In this context, physician communication during oncological informed consent consultations plays a central role []. For patients to provide informed consent and participate in shared decision-making, medical information must be understandable, relevant, and tailored to individual needs. However, achieving this balance is challenging. Excessive or unstructured information may overwhelm patients, while insufficient or overly simplified information may undermine patients’ autonomy and limit their ability to make informed choices. Therefore, physicians face an ethical and clinical challenge to adapt medical information to patients’ decisional capacities, values, and preferences while ensuring transparency and respect for autonomy []. Previous research indicates that patients with advanced cancer often have an incomplete or inaccurate understanding of their disease and prognosis. Studies have repeatedly demonstrated discrepancies between physicians’ intentions and patients’ perceptions of the purpose of treatment, with many patients believing that palliative therapies are curative in intent despite limited prognostic benefit [–]. Even after interventions to promote understanding (e.g. decision aids, discussions), a substantial proportion of patients continue to hold unrealistic expectations about treatment goals and prognosis []. Such misunderstandings may significantly influence treatment preferences and decisions, potentially leading to care that is misaligned with patients’ values or goals. While quantitative studies have provided important insights into the prevalence and consequences of limited prognostic understanding, less is known about how patients themselves experience physician communication and the process of receiving medical information in palliative care. In particular, there is a lack of in-depth qualitative research exploring how patients emotionally and cognitively process prognostic and treatment-related information over time, and how communication may become either manageable or overwhelming in palliative care contexts. Understanding these perspectives is essential for developing patient-centered interventions that are responsive to patients’ vulnerabilities, informational needs, and ethical concerns.