Objectives The treatment decision-making (TDM) process in the medical encounter in ovarian cancer (OC) is directed by oncologists. There is little information on oncologists’ perceptions of this process. Our objectives were to explore oncologists’ perceptions concerning (1) patients’ preference for involvement in TDM, (2) factors that affect when to introduce this discussion, and (3) strategies used for engaging women in TDM.

Methods We adopted a qualitative descriptive approach. Individual in-person interviews were used to collect data; themes were identified.

Results Fifteen gynecologic and 5 medical oncologists from Ontario, Canada, participated. We found that oncologists made the assumption that women with recurrent OC were interested in being involved in TDM but rarely reported attempting to validate this assumption. The oncologists timed the initiation of the TDM discussion based on their degree of certainty of recurrent OC and their perception of the patient’s readiness to be involved in TDM. Oncologists reported using strategies to engage women such as getting the women to take ownership of the decision, verbalize their priorities, lead the discussions, and giving the opportunity to gather information.

Conclusions Oncologists need to listen to each patient rather than make assumptions about the person based on her disease.