1. Harpham, Wendy S. MD

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In my December 25th column, I discussed some of the challenges patients face when making treatment decisions, especially when there is no single best treatment. This handout may help put patients in a frame of mind where they can hear what you say and process the information in healthy ways. As with all the handouts offered in this column, feel free to personalize it or use it as is.

WENDY S. HARPHAM, MD... - Click to enlarge in new windowWENDY S. HARPHAM, MD. WENDY S. HARPHAM, MD, is an internist, cancer survivor, author, and mother of three. Her books include

Making a Treatment Decision

Dear Patient,


You are faced with a treatment decision. The good news is that you have more than one treatment option. The challenge is that none is clearly best. That's because it is impossible to predict exactly how well each option will work for you or what side effects (or other problems) you might experience. Aside from the uncertainty, you also have to make a judgment call that weighs the upsides and downsides of each option against those of the other options.


Note: We are considering only science-based cancer therapies, because these are the only therapies proven effective against cancer.


Based on your medical condition, we will give you a target date for starting treatment. To work your way to an informed decision about the best treatment path for you, we will help you:


1. Make a complete list of all reasonable options for people in your situation;


2. Learn about the pros and cons of each option; and


3. Weigh all the pros and cons in the context of your life-your values and life goals.



The Stress of Decision Making

Patients often feel stressed when making treatment decisions. Reasons can include:


* You feel a sense of urgency to begin treatment;


* You've never made such a high-stakes decision;


* The sense of responsibility for the outcome can be overwhelming;


* Comparing the risks forces you to think about frightening possibilities;


* Once you proceed, you cannot undo your body's exposure to treatment;


* You desire certainty that you are choosing the right course of action.



Take comfort: The associated stress will subside as soon as you make your decision. You'll be able to shift gears immediately and stop talking (and thinking) about statistics and risks. You'll be able to nourish hope of the best possible outcome while focusing on getting through treatment.


That said, please don't rush to make a decision sooner than you need to. We understand if you want to start treating the cancer. But we cannot overstate the importance of doing whatever it takes to make the best decision. Your investment over the next days or weeks (e.g., the time and energy you spend obtaining information and weighing options) will serve you well forever after. Whatever happens, you'll be comforted by the confidence of knowing you did the best you possibly could.


Who Can Help

The better you understand what is-and is not-certain about your case, the better you can compare the risks and benefits to you of each treatment option. We will help you any way we can.


Others can help, too. Second opinions from other oncologists are a natural next step, if your condition allows. You're not looking for tie-breakers but, rather, for additional information or insights about the options you're already weighing. If conflicting information or the introduction of a new option increases the stress, we can deal with that. If consultants simply agree with everything you've already been told, you benefit from the positive reinforcement.


You may also benefit from talking with an oncology nurse, social worker, counselor, or chaplain-preferably one familiar with the challenges of medical decision making. Their perspective may help you interpret all the facts and uncertainty about your disease and treatment options in the context of your personal life goals and values.


Talking with other patients provides a different type of input that can be useful, especially if you connect with someone who seems to share your outlook on life. Just always keep in mind the limits of other patients' stories. What happened with them may not happen with you. And if their seemingly similar situation is, in fact, different than yours medically, you may be led dangerously astray. To avoid problems, be sure to review with us newly acquired information obtained that might be influencing your decision.


The Best Answer for You

Without a clear "right" answer, some patients feel stuck, unable to think about it anymore. Others keep researching and talking about it-on and on-with the belief that if they keep looking, eventually they'll find the "right" answer. Either way, it helps to let go of hoping for an absolutely certain "right" answer and, instead, to focus on determining the "best" choice for you based on the available information.


Sometimes the best you can do is to narrow it down to two (or three) equally reasonable, science-based therapies. What then? Can you still make a "best" choice? Yes. In this case, all your final options are "best" options. You can't make a wrong or bad choice. Whichever path you ultimately choose offers real hope of a better tomorrow.


To make that final decision, some patients listen to their gut feeling. Others look to their faith. Still others spend a few days imagining proceeding with one option, before spending a few days acting as if they are going to proceed with the other option. After going back and forth a time or two, one option usually feels best.


Remember, you want to do whatever it takes to make the best decision for you-a decision that gives you the best chance for the desired outcome.