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Purpose In Sweden, thousands of older adults undergo radiotherapy each year with either curative or palliative intent. Palliative radiotherapy aims to relieve symptoms while minimising treatment burden and maintaining quality of life. Treatment decision-making can be challenging, as symptom relief, treatment burden, and personal priorities must be balanced. Older cancer patients may face barriers, including frailty, emotional distress, and limited medical literacy, which may affect participation in decision-making. This study explored older cancer patients’ experiences of treatment decision-making regarding palliative radiotherapy. Methods An inductive qualitative descriptive design was employed. Seventeen cancer patients aged 70 years or older receiving palliative radiotherapy at three radiotherapy units in Sweden participated in individual semi-structured interviews. Data were analysed using reflexive thematic analysis. Results Participants’ experiences were shaped by acceptance of mortality, hope, trust in healthcare professionals, and perceived opportunities for participation. While some described communication and professional guidance that facilitated involvement, others viewed treatment decisions as largely predetermined. Trust in healthcare professionals was often experienced as a valued form of delegated decision-making but could coexist with limited autonomy. Continuity of care, clear communication, and being recognised as a whole person were central to feeling supported throughout the decision-making process. Conclusions Participation depended not only on being offered choices but also on communication, shared understanding, timing, continuity of care, and relational support. Strengthening these aspects of care may facilitate more meaningful involvement in decisions regarding palliative radiotherapy.