When It's Cancer -- How to Make Tough Decisions

You’ve been diagnosed with early-stage breast cancer. Now the real job begins — you need to weigh the risks and benefits, to make decisions. But how?

By Rachel King

Decisions Based on Emotion vs. Facts

Two new studies suggest that when confronted with cancer diagnoses, we’re likely to make decisions based on emotion and anecdotes rather than on facts and scientific evidence. And that’s no way to do it.

In a University of Michigan study published in the Journal of General Internal Medicine, researchers presented 2,399 people with a hypothetical health emergency and instructed them to choose a course of action. Some of those surveyed were asked to think of themselves as patients; others were told to imagine themselves as the parent of a patient, the doctor of one, or a hospital medical director making healthcare decisions for an entire community. Surprisingly, the most emotionally distant relationship — between the medical director and the public — yielded the results that most reduced risk, favoring aggressive treatments that gave patients the best chance of staying healthy. On the other hand, study participants asked to envision themselves as patients were least likely to choose potentially life-saving interventions.

"When you’re the patient, your tendency is toward treatments with fewer side effects than aggressive ones," says Brian Zikmund-Fisher, PhD, research investigator at the University of Michigan Medical School in Ann Arbor and lead author of the study. And in a study published in Cancer, researchers studied 20 newly diagnosed patients with prostate cancer, and found that their treatment preferences were influenced by apprehension, misconceptions about treatment options, and a desire for rapid treatment, rather than a careful consideration of medical information. "Fear can cause people to make precipitous and ill-informed decisions," says study author Thomas Denberg, MD, of the University of Colorado Health Sciences Center in Denver. A full three-quarters of the subjects said that they had no intention of seeking a second opinion. Forgoing another opinion gives you the short shrift, explains Denberg: "If the second doctor disagrees with the first doctor’s choice of treatment, it opens things up for discussion, which benefits the patient."

Emotional situations, such as hearing "you have a malignant tumor," aren’t ideal for critical thinking. "When you are in a state of anxiety, your ability to make decisions is compromised," says Marisa Weiss, MD, president and founder of breastcancer.org. "And you may rush to a decision just to make one. Good decision-making means taking a look at the question from all sides."

Zikmund-Fisher explains, "When we’re choosing for ourselves, we’re very sensitive to the possibility of doing ourselves harm." Often, we get stuck fearing all the side effects of a regimen even though rationally we know that more aggressive cancer treatments tend to offer the best hope for recovery. You might assume your doctor would make the same decisions are you would, but that’s not necessarily true because he or she sees the situation from a different perspective. Before you choose your treatment, don’t just examine your own feelings. Ask yourself: What would Susan Love have me do?

Guidelines in the Decision-Making Process

Other guidelines in the decision-making process include:

Set a schedule. Decide with your doctor how much time you should take to make your decision — and then don’t rush it. Get a second opinion. Talk about your concerns with people you trust. Zikmund-Fisher recommends considering as many different opinions as possible. "Examining your situation from a different point of view may help you see different pieces of information that are relevant." You may end up making a different choice, but even if you don’t, you can be confident you’ve made an informed choice.

The Ottawa Health Research Institute’s Web site is full of resources, such as interactive quizzes and facts to consider regarding common medical quandaries.

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