Objective To identify the multidimensional needs of treatment decision-making in patients with metastatic spinal tumors based on the journey map, and to provide a reference for meeting the decision-making needs of this group.Methods A descriptive qualitative study was designed, and 17 patients with metastatic spinal tumors were selected to conduct semi-structured in-depth interviews, then the content analysis method was used to analyze the interview data and draw the journey map.Results According to the timeline of diagnosis and treatment, from the four dimensions of task, touch point, emotion, and pain point, the treatment decision-making needs of patients with metastatic spinal tumors were summarized into 32 themes:weak health consciousness, difficulty in seeking medical treatment, difficulty in understanding treatment plan, difficulty in acquiring and distinguishing information, treatment related symptom distress, etc., which were categorized into screening period (11 items), treatment decision-ma-king period (11 items) and treatment period (10 items).Conclusion The treatment decision-making journey in patients with metastatic spinal tumors is complex, and their needs for treatment selection, treatment decision-making, and symptom management are prominent.It is suggested to standardize online health information, develop a medical evaluation platform, build a nurse-led and family-involved online interactive patient decision aid, and apply the Electronic Patient-reported Outcome (ePRO) to implement intelligent symptom management, so as to meet the health needs of patients during the pretreatment decision-making period.