Pathologic 2 - it’s a really stressful game, but I think it’d be perfect for the criteria. The choices matter aspect are intertwined in both how you spend your time (it’s limited and you can’t be everywhere at once), and in quests (the more traditional choices, like pick A or B or C). Don’t want to spoil any more but it’s amazing, you don’t need to play the original.

Besides it, I’ve also heard good things from Pathfinder: Wrath of the Righteous, though I haven’t played it personally.