It's definitely a game with a lot of choices in how you fulfill missions. (including failure - the game is tolerant enough of different approaches that you can piss off every single major and minor faction and still have a path to the endgame) And your actions do have consequences to the world around you. A lot of this is in how the postgame slides describing the future of the various groups play out, but there are also plenty of cases where certain actions will enable or lock out other possibilities, and you will eventually align yourself with one (or none) of three major factions, which will limit your interaction with the other ones (and with the minor factions which have their own alignments and agendas)
Mechanically, it's very much like Fallout 3. A few tweaks, mostly for the better, but it feels pretty much the same. It does have the same problem from an RPG perspective that specialization breaks down later in the game when your character has enough skillpoints to be basically good at everything, especially with the DLC installed.