Making Tough Medical Choices

Strategies for Decisions on Your Own Terms

From the moment you receive a cancer diagnosis, choices abound. These choices can be related both to your cancer/medical situation and to your larger life that will certainly be impacted by your diagnosis and treatment. 

The first medically related decision is picking a doctor or a hospital. You will be thinking about reputation, relationship, finances, insurance and convenience. Later decisions are related to understanding treatment possibilities and, if relevant, making the best choice for yourself. Still others may someday relate to stopping treatment and deciding to focus on quality of life.

It likely was easier in the era when patients were expected to simply follow doctors’ orders. Now good doctors involve their patients in decision-making. While this creates a positive sense of involvement and empowerment, it can also cause some anxiety, uncertainty and pressure—especially if family members or friends have different ideas.

These strategies can help you keep these decisions in perspective and ensure you are making choices on your own terms:

1. Whatever the situation, create a list of the pros and cons.
2. Get as much information as you can. You can decide whether you want to immerse yourself in the medical literature or read very little. You can delegate the research to a friend or family member or ask your doctor to explain the possibilities and make recommendations.
3. As you choose your doctors, do think both about reputation and competence as well as logistics. Remember that no one physician or institution has any secret information or magic. All good oncologists work from the same knowledge base and have access to the same protocols. Clearly this is not always the case when considering clinical trials, but it is true for standard cancer care.
4. Stick with reliable websites, such as the American Cancer Society, the National Cancer Institute or the American Society of Clinical Oncology patient website. Be careful not to do too much Internet research. Stop reading if you start feeling anxious. For everyone, there is a moment of overload. Remind yourself that you are not going to be able to learn everything, and that it is not necessary to do so.
5. You almost always have time to consider your choices. Cancer is very rarely a medical emergency.
6. Consider speaking to a few people who have similar diagnoses or considered the same surgical or treatment options as you.
7. All of us have different priorities and worries, and identifying yours may make things clear. For example, if you have small children, you may be most concerned about the recovery period and your ability to meet your responsibilities.
8. Don’t obsess over statistics or worry that there is only one right choice. Statistics describe the experiences of large groups of people; no one knows what the outcome will be for any one person. You are an N of one.
9. Pay attention to your gut as well as your brain.
10. Identify the worst possible outcome of a set of options and do your best to avoid it. This strategy can help you focus.
11. Virtually none of these choices mean the difference between life and death. If they did, your doctor would be telling you what to do. For many people, the choices are among several good treatments and, in some cases, include clinical trials.
12. As the patient, the final choice is yours.