No one wants to be a good patient: Intersectionality and agency in the sick role

Making treatment decisions is a responsibility of the sick role granted to ill people. Despite many social roles being granted to ill people, intersecting with the patient role, little is known about what roles and how they intersect in decision-making, particularly what motivates patients to perform patient behaviors under this situation. This study explores the intersectionality and agency in the sick role in cancer treatment decision-making. Thirty-two interviews with cancer patients reveal the multiple identities, intersected identities, and preferred identities in decision-making on cancer treatment. Surprisingly, the findings show no one claims that they want to be a good patient. The agency to perform a patient role comes from the non-patient preferred identity. This finding informs a narrative approach that regards cancer patients as persons situated in multiple social systems and narrative contexts and thus physicians and all the healthcare stakeholders can facilitate patients’ preferred identity to improve their agency in treatment decision-making. © 2025 Elsevier Ltd