Dr Vikki Langford, Clinical Psychologist at Birmingham Children’s Hospital, explains some of the factors involved in making decisions and offers advice and guidance on the process.
We each make thousands of choices every day, often without even being aware that we’re doing so. The vast majority of them are trivial, though on occasions we’re faced with much more important, sometimes life-changing decisions. There are often no quick, easy or straightforward answers and we may be left pondering the ‘best’ way of reaching a conclusion.
Some decisions that we make in life are instinctive, while others require a significant amount of time, effort, research and energy before we feel able to make a final choice. The bigger decisions in life are often accompanied by a degree of risk, ambiguity or uncertainty which make the choice even harder to make.
What can influence our decisions?
Decision making is unique to each of us. It’s a psychological process underpinned by our own values and life experiences. How we approach decision making is often influenced by:
- How much time we have available to make the decision
- What information is available to us regarding the different options
- Our own assessment of the risks involved
- An ability to weigh up the above knowledge and reach a conclusion that suits us best
In many ways, it may be easier to reach a conclusion if the outcome of the decision affected only ourselves, though the older we get, the less this is likely to be the case. We may need to consider the implications of our decision making on our partner, children or wider family members. Perhaps we may even be making decisions on behalf of someone else who is incapable of making their own choice, due to their age, maturity or cognitive ability.
How can we help ourselves to make these difficult decisions in life?
Often, we choose to seek the advice of others, whether this is a trusted friend or a person of authority in the area. It can be helpful to get a different perspective and many people find the views of others useful, particularly when the topic being debated is something they’ve limited knowledge of. Experts can come in many forms; a specialist in their field, someone in a position of status such as a faith leader or perhaps an ‘expert by experience’ - someone who’s been in your position before.
What tools may help us in our decision making?
Many people find the following ideas helpful in guiding their thinking:
• Decisional balance sheet: pros and cons list
• Cost/benefit analysis: what do I stand to win vs what do I stand to lose?
• Emotional forecasting: if I chose ‘X’, how would I feel?
• Consideration of permanency: is this decision final or could I change my mind later?
• Advise yourself as if you were a friend: what would Dave do?
• Visualising each of the different options and outcome
The information age: a blessing and a curse
In the modern age, we have a wealth of information at our fingertips. Who hasn’t consulted Google at least once this week?! But while availability of knowledge can be very useful in gathering information to help us make decisions, it can also lead to information overload. We can’t possibly seek to learn everything there is to know about important topics in life, there will always be an element of the unknown.
Looking after yourself when making difficult decisions
Whatever tool you choose to use, it’s important to look after your emotional wellbeing while making tough choices. Some people find externalising their thoughts and feelings to be helpful, writing them down, drawing diagrams or being creative. Allow yourself dedicated ‘thinking space’, along with times when you are consciously switching off the thought process and allowing yourself to rest. Spend time with the people who are most important to you and get some fresh air if at all possible - being surrounded by nature can be an incredibly grounding experience.
Availability of too much information can lead to ‘analysis paralysis’, a phenomenon that can occur when someone’s unable to reach a decision due to information overload. They may get stuck going over the same material over and over, unable to reach a conclusion.
Involving young patients in the decision-making process
When the decisions being made - as is often the case in childhood cancer care - are on behalf of children, this can be a tricky path to navigate. How much should they be told? How much influence should they have over the final decision? Should they be told that there’s a choice to be made at all?
As in all aspects of their care, psychologists would advise that children should be given honest, developmentally appropriate explanations of what’s going on. A little information at first, with opportunities to ask questions if they choose to, at any point. Sometimes they will have questions to which there may not be an easy answer and honesty here is also important: “I don’t know, but we could ask Dr Smith” or “I don’t know that there’s an answer to that.” Where appropriate, children’s views should of course be considered, though children are far less likely than adults to be able to see beyond short-term consequences of their choices. Be clear with your children when asking them for their opinion, if ultimately the final decision will not be theirs to make.
Teenagers are perhaps more likely to wish to be involved in any decisions which impact upon them and they’re more likely to be able to weigh up the pros and cons than their younger counterparts. In medical care, young people, even those under the age of 16, have a right to be involved in conversations regarding their care and to make decisions that impact them. Clinicians will always give consideration to young people’s ability to understand and weigh up the options available to them, along with their ability to explain how and why they have reached any given decision.
Support from psychologists
When supporting children and young people to reach their own decision or be a part of the decision-making process, all of the suggestions above may be equally as useful, though they may need support to structure their thinking or a safe space with someone independent in which to explore their feelings. Clinical psychologists form a part of all paediatric cancer care teams and are happy to provide a space to think about important choices.
Remember:
Whatever method we choose to make decisions, we can ultimately only make them based upon the information that we have available to us at the time. There may be scope for research, seeking out the opinions of others, or weighing up the pros and cons, but when push comes to shove, the final decision is ours and ours alone. There’s no right or wrong choice, each decision is a judgement call based upon our own individual life experiences and the set of unique values by which we choose to live our lives. And while we all have a tendency to reflect on the ‘What if’ after the event, none of us can predict the future. We’re all doing the best we can in the circumstances in which we find ourselves.
