How Do I Make Treatment Decisions? Read Up

When you learn that you have a specific disease or condition, it can be confusing and overwhelming. There are many resources and sources of support to help you.

After you have learned about treatment options (from your provider and your own research), you need to make a decision about what is best for you.

What should I consider when making treatment decisions?

There are several things you will want to consider when making any treatment decision:

• Risks: What are the risks or problems associated with treatment? Be sure you understand the side effects and potential for complications. Also investigate the financial costs.
• Benefits: What are the potential benefits? How will the treatment address your problem?
• Evidence: How much evidence (research or experience) exists? Does it support the efficacy and safety of the treatment?

It is often helpful to consider the risks, benefits, and evidence together. For example, you may decide to pursue a course of treatment even if there is only a moderate amount of research for it but the potential benefits are high and the known risks are low.

On the other hand, if the risk of a treatment is high and the benefit and research only moderate, you may not chose to pursue it. Our treatment decision model under the Apply It tab helps you weigh these three factors.

In addition to these factors, there are two other things you might want to consider:

• Is the treatment or therapy compatible with your personal values and preferences?
• Is it accessible at a reasonable cost?

Getting help with your decision

Making a treatment decision can be complex and emotional. Luckily there are tools to help you weigh all the factors that apply in your individual situation. Some of these can be found online.

An online decision support tool can help you learn the facts and evidence behind every option while taking into consideration your personal feelings about the outcome. The tool guides you through a number of questions before making an objective assessment about what outcome might be most beneficial for your wellbeing. You are able to research your options in the comfort of your own home, without feeling pressured or put "on-the-spot" in the doctor's office.

Here's an example. Let's say you are a woman who has a high risk for breast cancer. You have several options. You could get extra checkups and do self-tests at home, or you could opt to have preemptive surgery. If you decide to get surgery, you could get a mastectomy, oophorectomy (a surgery to remove the ovaries), or both. Each of these options carries a different risk and benefit. A decision support tool will take into account both the quantitative and qualitative benefits of each outcome: it will consider the fact that a mastectomy will greatly lower the changes of getting breast cancer, but also how surgery might affect your self-esteem and feelings about your body.

Where can I find online decision support tools?

The Ottawa Hospital Research Institute has an excellent site that offers a personal decision guide and a searchable index of health topics. Healthwise is another site with decision tools for a wide variety of topics and conditions.

The Foundation for Informed Medical Decision Making is an organization that offers DVD and VHS-based decision support tools, which can be ordered from their website.

Are there special considerations for integrative therapies?

If you are considering using an integrative therapy, you will want to do the same analysis as for any treatment, considering the risks, benefits, and evidence. Has it been used successfully to treat the specific condition you have, and does it make sense for you?

Here are a few things to keep in mind with integrative therapies:

• "Natural" does not necessarily mean safe. Some mushrooms are safe and healthy to eat while others are poisonous!
• Not everyone responds the same to treatments. Individual factors need to be considered.
• Remember to discuss your use of integrative therapies or questions you may have with your healthcare provider. Even if there is evidence that a particular integrative therapy in general is safe and effective, it may not be right for you.

Whether you are purchasing a product or seeing an integrative practitioner, know what you are buying.

Are there any cautions with using integrative and conventional approaches together?

Realize that conventional and integrative approaches should not always be combined. Consider the following true story. After being on the organ transplant list for three years, Linda was relieved and grateful when the call came that a lung was available. Following the transplant, she would be able to resume many of the daily activities that had become impossible.

As with many patients after transplant, Linda continued to face some significant health challenges and experienced some depression. Linda wondered about taking the herbal medicine St. John's Wort to help and asked the nurse transplant coordinator about it.

The nurse explained that this particular herbal medicine would be very dangerous to take as it interferes with the prescription drug (cyclosporine) that Linda was taking to help her to not reject her newly transplanted lung. In this situation, taking the herbal medicine could have had a very negative impact on Linda's health.

In summary

When making any treatment decision, you should consider the risks, benefits, and supporting evidence for the treatment. In addition, you should consider if the treatment is compatible with your personal values and preferences and if it is accessible at a reasonable cost.

When considering integrative therapies, use the same analysis and don't assume that natural means safe.