When I agreed to write this column in this edition of Contact, themed on ‘Choices’, I thought it would be easy. But it wasn’t – just like the choices that families have to make.
When you’re in a situation of stress, your mind jumps to emergency mode and your decision-making ability alters. That’s good if you’re in the jungle and have to instantly decide whether to hide from, run away from or fight the wild animal you’ve just spotted. But it’s not so good if you need to assemble facts, consider all the options, view the situation widely and factor in other unknowns in the future.
Hobson’s choice – take it or leave it – is annoying. However, too much choice can be paralysing. The choices that families have to make are often a balance between two competing things and the dilemma – between a rock and a hard place - is painful. For example, treatment ‘X’ may increase the chance of cure but at a likely cost of more permanent side effects than treatment ‘Y’.
The compromise – something has to give - means that you may need to be prepared to sacrifice something else to achieve what you feel is most important. If we want treatment ‘Y’, we may need to travel to another city and that will cost us in lost wages. Our other children will need to be looked after and need us, too. If we stay and have treatment here, will there be definite consequences in terms of cure or in terms of side effects or is it just a possibility?
So, how do I help people choose? I have to summarise the information that we have about the condition, the treatment and the outcomes. I need to frame these for families so that they can understand them. In an emergency, like a cardiac arrest, the clinician chooses for the patient. Occasionally, in a non-emergency situation, a menu of choices is offered and it is all left to the patient or family. That is less common in complex ongoing conditions such as the treatment of cancer. Usually, the clinician finds out what outcomes are most important to the patient and family and recommends one treatment over another, explaining why.
As always, if you find you are unsure on something, please ask questions. Write them down, and don’t be afraid to ask for help if you need it.
