A person with cancer may have more than one option for treating the disease, and it may be difficult to choose among them. In making this choice, patients often ask for the opinions of family members. And, in some cases, family members may disagree with each other and with the patient, creating conflict when they need each other's support the most. This is particularly complex when the patient is a child or an adult who is medically unable to make decisions. This article provides suggestions on how to keep the lines of communication open and work together to make treatment choices.
If you are involved in selecting treatment, these questions may help you evaluate the choices:
- Does the patient understand the risks of treatment and the potential consequences of his or her choices?
- Are the patient's wishes openly stated and being respected?
- Is this treatment in harmony with the patient's beliefs and values?
In each aspect, the patient's viewpoint is considered first. If you are a person with cancer, you have the right to be heard, the right to state your wishes and have them respected, and the right to change your mind. If you are a family member, remember that the patient has asked for your view because he or she respects your opinion, but various factors may lead him or her to make a different decision. Even when disagreements occur, it is important to keep communicating with each other and to support the patient in his or her choices.
Talk openly about the patient's priorities in undergoing treatment. These could range from surviving as long as possible, regardless of the difficulty of treatment, to maintaining a specific quality of life, even if that means stopping treatment. If this is difficult for your family to discuss, ask someoneâsuch as a doctor, nurse, member of the clergy, social worker, or counselorâto facilitate this conversation.
Barriers to talking about treatment options
There may be many different reasons why it is difficult to talk openly about treatment options:
- Emotions, such as sadness, fear, anger, and confusion
- Family patterns of talking about health care, including differences in how generations communicate
- Cultural, spiritual, or religious beliefs about health, illness, and death
- Misconceptions or lack of knowledge about treatment, side effects, and prognosis (chance of recovery)
- Fear of giving up independence and the effect on lifestyle and finances
- Fatigue or exhaustion from current treatment
- Denial or the belief that if you don't talk about it, it isn't really happening
- Past experiences with cancer and other illness
It is important to identify potential barriers and start talking with each other so that you can get the information, support, and resources you all need to make the best choices.
Continuing to communicate
Making treatment decisions may require many conversations with doctors and other members of the cancer care team and with family and friends. One of the first questions to ask the oncologist is when the treatment decision needs to be made. Often, a decision is not needed immediately, and this can reduce the level of anxiety for everyone involved in reviewing the various options.
An advance directive is a legal document that tells the health care team what to do if the patient is unable to make decisions. Such documents can be changed or cancelled if the patient changes his or her mind about the choices, but the patient is the only person who can change them. Regardless of their health, all people should have advance directives, including the following:
Living Will. This document gives instructions about the health care that the patient does and does not want under specific circumstances.
Health Care Power of Attorney. This appoints a specific person to make medical decisions based on the patient's wishes. It only takes effect when the patient is unable to make his or her own decisions. Learn more about advance directives.
State laws vary in determining the age at which a child can make his or her own medical decisions. Most laws consider the child's best interests, ability to make his or her own decisions, and ability to understand potential consequences of decisions. Typically, the parents make decisions for a child who is below the state's age limit.
If an adult patient is unable to make medical decisions, family should look first for any advance directives indicating the wishes of that person. If there are none, follow the intent of that person's wishes. The person's treatment facility should be able to refer you to a medical ethics committee or palliative care team that can help guide you through the decision-making process. Attorneys and legal-aid clinics can also be helpful in addressing legal concerns.