Overall, I really enjoyed this game. The world is bleak, otherworldly, and full of secrets and surprises. The PS1-esque graphics add a lot of charm and add to the cosmic horror style of the game by letting your imagination fill in visual gaps left by the low-polygon models. Plus the shifting textures give add to the weirdness of the world.
Your choices matter, both narratively and from a gameplay perspective, though you'll find most choices don't have a big effect on the world during your playthrough. Big choices mostly have an effect on the ending and the story but only make small changes to the world itself. Gameplay-wise, choices usually just dictate which rewards you get, which might sound like a small thing, but when the rewards are unique items and permanent upgrades, it's important to know you could be locking yourself out of some really useful stuff with your decisions.
One big thing that prevents this from being a 5-star game is the combat. For such a big part of the actual gameplay, it's incredibly basic and laughably easy. The only times I ever died or even got below half health was from fall damage. Even from the start, most enemies die in 2 or 3 hits with a rusty sword, and you only continue to get more powerful, with better armor, weapons, and spells. Don't get me wrong, it can be fun to just completely annihilate everything in your path, but it becomes boring when there is nothing that can really challenge you combat-wise.
Another part of the game I would have liked to have more impact was the faction system. There are several factions in the world that have their own opinions of you based on your decisions, but there are only two factions that reward you becoming friendly with them, and the rewards are very small. Also, most factions in the game just exist to hate you - there is no way to increase your reputation with them, and they start out hostile toward you. Honestly this system overall is so crude and underused that the game would simply be better without it.
Other RPG aspects of the game are solid though. There are almost always multiple paths to solving a problem in the game, and typically multiple ways to reach a chest or delusion too. But while your stat allocation is important early game, you realize pretty quickly that clothing, rings, and items improve your stats so much that you usually just need to switch clothes (which you can do any time you want) to solve a problem.
All that being said, I thoroughly enjoyed this game and I contonue to think about it even after completing it. I may even do another playthrough just to see what would happen if I made different choices. If you enjoy open world games with good writing and impactful choices, I suggest you try it out.