在肿瘤学实践中实施共同决策通常是有限的，特别是将患者的情况纳入决策中。为了改善这一点，我们开展了质量改进项目 CONtext。 CONtext 试图通过以下方式实现这一目标：(1) 在与肿瘤内科医师会诊期间将患者的情况纳入共同决策中； (2) 积极让全科医生和病例管理员（一名专门的肿瘤科护士）参与进来，他们通常了解患者的情况； (3) 给予晚期癌症患者长达 2 周的暂停时间，与其他人（包括亲密的家人和朋友）考虑和讨论治疗方案。探讨晚期癌症患者及其相关专业人员如何经历共同决策引入 CONtext 后。使用深入访谈和归纳内容分析进行定性嵌入式多案例研究。有目的的 14 个案例样本，每个案例由一名晚期癌症患者以及理想情况下的肿瘤内科医师、病例经理和GP. 确定了四个主题：共同决策是一个动态且持续的过程 (1)，其中肿瘤科医生的治疗建议是核心 (2)，并由患者没有选择的经历推动 (3)，以及将患者的情况纳入共同决策被认为很重要，但受到阻碍 (4)，例如，与终末期的关联。肿瘤内科医师和晚期癌症患者优先考虑延长生命的抗癌治疗的普遍趋势限制了这种潜力以便共同决策。这破坏了将个人情况纳入决策，而决策是姑息治疗连续体的一个关键方面。

Implementing shared decision-making in oncology practice is often limited, particularly integrating the patient's context into decision-making. To improve this, we conducted a quality improvement project, CONtext. CONtext attempts to accomplish this by: (1) Integrating the patient's context into shared decision-making during consultation with the medical oncologist; (2) Actively involving the GP and case manager (a specialized oncology nurse), who often have knowledge about the patient's context, and; (3) Giving the person with advanced cancer a time-out period of up to 2 weeks to consider and discuss treatment options with others, including close family and friends.To explore how persons with advanced cancer and their involved professionals experienced shared decision-making after the introduction of CONtext.A qualitative embedded multiple-case study using in-depth interviews analysed with inductive content analysis.A purposive sample of 14 cases, each case consisting of a patient with advanced cancer and ideally their medical oncologist, case manager, and GP.Four themes were identified: shared decision-making is a dynamic and continuous process (1), in which the medical oncologist's treatment recommendation is central (2), fuelled by the patients' experience of not having a choice (3), and integrating the patient's context into shared decision-making was considered important but hampered (4), for example, by the association with the terminal phase.The prevailing tendency among medical oncologists and persons with advanced cancer to prioritize life-prolonging anticancer treatments restricts the potential for shared decision-making. This undermines integrating individual context into decision-making, a critical aspect of the palliative care continuum.