Every treatment has trade-offs. The best treatment for you may be different from the best treatment for your friend or neighbor. We all have individual needs, and different things are important to each of us.

If you play a part in making decisions about your treatment, you are likely to recover quicker than if you do not.

 

 

 

 

 

Source:
Arora NK. McHorney CA
Patient preferences for medical decision making: who really wants to participate?
Medical Care. 38(3):335-41, 2000

 

 

 

 

 

¹ It is even more important to take part in making decisions when doctors do not know which treatment is best for you. Doctors should base their treatment decisions on what the research tells them. If your doctor knows what the research says about how to treat a condition and uses this information to make decisions about treatment, then he or she is practicing evidence-based medicine. This is a good way to practice medicine because it means your doctor is using evidence from medical studies that have looked at what happens to many thousands of people.

• Check out all your choices.
• Make sure you understand the risks and benefits of treatments or of doing nothing.
• Make sure you understand how the risks and benefits will affect you specifically.
• Make sure you have enough information to make a choice.

You and your doctor should talk about your options for treatment and make a decision together about the best treatment for you. This process of working together is often called shared decision making. Whenever possible, you should work with your doctor to decide on the best treatment for you.You should ask these questions before deciding on any treatment:

• How involved do I want to be in making decisions about treatment?
• What will happen if I do nothing?
• What are my choices for treatment?
• What are the benefits and harms of each treatment?
• How do the benefits and harms balance out for me?
• Do I know enough to make a choice?
• How can I work through my choices?

Research shows that some people want to actively involved in making their own decisions about treatment.

 

 

 

 

 

Source:
Deber RB, Kraetschmer N, Irvine J
What role do patients wish to play in treatment decision making?
Archives of Internal Medicine. 156(13):1414-20, 1996

 

 

 

 

 

² Others don't want to be involved at all. Research also shows that doctors often suggest one type of treatment when their patients would prefer another.

 

 

 

 

 

Source:
Deber RB, Kraetschmer N, Irvine J
What role do patients wish to play in treatment decision making?
Archives of Internal Medicine. 156(13):1414-20, 1996

 

 

 

 

 

² Your doctors may not always know what is important to you.One study looked at what happened when men with prostate cancer who were thinking about having their prostates taken out were shown a video of men who had already had the operation.

 

 

 

 

 

Source:
Flood AB. Wennberg JE. Nease RF Jr. Fowler FJ Jr. Ding J. Hynes LM
The importance of patient preference in the decision to screen for prostate cancer. Prostate Patient Outcomes Research Team.
Journal of General Internal Medicine. 11(6):342-9, 1996

 

 

 

 

 

³ In the video, the men talked about the side effects of surgery. After watching the video, many of the men decided not to have surgery and to live with their symptoms. It's probably a good idea to play a part in choosing your treatment. Many common health problems, such as colds and headaches, go away on their own. Some health problems may get worse if you don't have treatment. Diseases such as diabetes and high blood pressure fall into this group. You can ask your doctor what will happen if you don't have treatment, but sometimes your doctor won't know what will happen. Your doctor may suggest that you make changes to your lifestyle before trying medications or other treatments. Lifestyle changes are things like exercising, eating a healthy diet and quitting smoking.If you make changes to your lifestyle, you may be able to avoid taking medication or having other treatments. Exercising more often and cutting back on how much alcohol you drink might help lower your blood pressure. If you don't want to exercise, it's better to be honest with yourself and your doctor. You may need medication sooner, but if you know you will never exercise then it's best to say so. There may be several different medications available. If your doctor prescribes one treatment, ask if there are others. Is surgery a possibility? Are there other treatments besides medicine or surgery? You may be able to try treatments such as physical therapy or acupuncture. It's good to know about all the treatments that might work. This will help you choose the treatment that is best for you. You may also want to hear about what other people with your condition have chosen to do and what their experience has been. For each condition on this Web site, you can find examples of other people's experiences. We hope they will help you. And you can also tell us your story, which might help other people like you. All treatments may have both benefits and harms. Just because a drug or treatment has been approved by the Food and Drug Administration, doesn't mean that it is completely safe. Even aspirin and acetaminophen (Tylenol) can have side effects. You always need to balance the possible benefits with the possible harms. No medication is harmless.Sometimes side effects don't show up in research studies and we only find out about them years after a medicine has become available. Even complementary or alternative treatments (whether herbal products, chiropractic care or vitamins) can be harmful. Just because something is "natural" does not necessarily mean it is safe. What matters is whether you think that the benefits outweigh the risk of any harms. Each person is different. You need to decide what benefits and what possible harms are important to you. Here are some things to consider.

• Your personal situationDoes the treatment have side effects that will be tough for you to live with? For example, maybe you have small children and so you can't take medication that makes you sleepy.
• How you have to take the medicationMaybe you don't like taking pills and would prefer to get your medication in the form of a skin patch.
• Your preferences for treatment and what you expect from itWould you find it difficult to live with the risk of any serious side effects even if the risk is small? Would you find it unbearable to lose your hair as a side effect of the medication you are taking? Even if the treatment increased your chances of staying alive after being diagnosed with breast cancer? What's the most important thing you want the treatment to do for you? If you have heart failure, what is more important to you to breathe more easily at night or to have less swelling around your ankles?
• How you cope with side effectsIf you have high blood pressure, for example, you may decide that you can put up with the annoying dry cough caused by some medications. For you, the benefit of the treatment (reducing your risk of heart disease and of having a stroke) might outweigh the downside of the treatment (the cough).But many people with high blood pressure don't feel ill. It can be harder to put up with side effects from drugs when you don't feel sick. For example, if you feel well but your medication for high blood pressure makes you dizzy, you may not want to put up with that side effect. But if you are sick with a chest infection you may put up with the diarrhea that is caused by taking an antibiotic to treat your infection. You should talk with your doctor before stopping any medication that he or she has given you. Sometimes another medication may work just as well and have fewer side effects.
• How big the benefit may beTreatments don't always cure symptoms. Your may decide that it is not worth taking a medication because the possible benefit is not big enough. You need to make sure you fully understand what the benefit of a treatment is before you stop it. If you have high blood pressure, you may think the medication you take every day is a waste of time. You feel OK. So why take the tablets? But if you stop taking them, you increase your risk of having a stroke or a heart attack.
• Your ageIf you are 40, for example, and have osteoarthritis and your hip always hurts, you may want to weigh the benefits and harms of having your hip replaced. If you have a hip replacement, your pain will go away and you'll be able to get around better. You won't have to take painkillers all the time. But your artificial hip may need replacing after 10 or 20 years. This is because your artificial hip may have worn out by then. You also have to weigh the harms of possible complications from surgery.
• Your sexual activityYou may decide that side effects that interfere with your ability to have sex are especially important to you. Make sure you ask your doctor about sexual side effects if they are important. If you are a man, you may find that some medications interfere with your ability to have an erection. You may run the risk of having problems getting an erection or becoming incontinent if you have some surgical procedures, such as treatments for prostate cancer or other prostate problems. (Incontinence is the term doctors use when a person can't always control when they go to the bathroom.) Your doctor should be able to talk freely about sexual issues with you. You certainly have the right to discuss them.

For an example of what to consider, see Weighing the benefits and harms. To make well-informed decisions about benefits and risks, you need reliable information about how likely it is that a benefit or harm will happen to you.If your doctor makes vague statements like, "The risks of this operation are small," then you need more information. What your doctor means by small may not be what you mean by small. Is there a 1 in 100 chance the surgery will cause a stroke or a 1 in a 1,000 chance? What the doctor considers a small and acceptable risk to take may be unacceptable to you.The way statistics like these are described to you can make a difference to how you feel about them. If you are told that a medication will cut your risk of having a stroke by 50 percent (what doctors call a reduction in "relative risk") this may sound great to you. But if it actually cuts your risk of having a stroke over the next five years from 2 percent to 1 percent (a reduction in "absolute risk"), then that doesn't sound quite so great.Similarly, hearing that using a drug doubles your risk of developing leukemia in 20 years may sound scary. But if your risk of getting leukemia is small to start with (say, 2 people in 100,000 will get it), then even if the risk is doubled, it is still very small. However, if you are worried about any risk of getting leukemia, even this risk may be too high for you.For more information about risks, see Understanding risks. Let's look at an example. Say you are a 50-year-old woman with a lump in her breast. The lump is about the size of a quarter. You have two children and live in Chicago. Your mammogram shows that something isn't normal. You have a needle biopsy (in which a thin needle is inserted into your lump to remove some cells). The biopsy confirms that you have cancer. Your surgeon recommends that you have your breast removed. We have used information from the breast cancer section of Consumer Reports Health.org to answer the following questions. There are only a few studies that show what happens if you don't have treatment for breast cancer. It would not be ethical to do nothing for a woman with breast cancer because there is enough evidence about what happens to suggest that her cancer will get bigger. The main options for treatment are to remove the breast or to remove the cancer and leave most of the normal breast tissue behind. (Removing the breast is called a mastectomy. The other type of surgery is called breast-conserving surgery.)After surgery, there are other treatment choices to consider depending on whether your breast cancer has spread to the

 

 

 

 

 

lymph nodes
Lymph nodes (also called glands) are small, bean-shaped lumps that you cannot usually see or easily feel. They are located in various parts of the body, such as the neck, armpit and groin. Lymph nodes filter the lymph fluid and remove unusual things, such as bacteria and cancer cells.

 

 

 

 

 

lymph nodes in your armpit. Also, if you have breast-conserving surgery, you may need radiation therapy afterwards. If you were a 50-year-old woman with breast cancer, you would need to weigh the following information about treatments.

• You will not live longer if you have your whole breast removed instead of having just the lump removed (breast-conserving surgery). There is also no increase in the risk of your breast cancer coming back if you have breast-conserving surgery.
   
   
   
   
   
  Source:
  Dixon M;Rodger A; et al.
  Breast cancer: non-metastatic
  1218-1246
  
   
   

   

   
   
  ⁴
• If you keep your breast, you have a 90 percent chance that your breast will look good afterwards. But you will need radiation therapy after surgery. And the side effects from that can make you feel tired and sick. If you have children, for example, you need to know that radiation therapy can be exhausting and stressful.
• If you have breast-conserving surgery, there is also a risk that not all of the cancer will be removed if just the lump is taken away. About 1 woman in 10 needs surgery again.
• If your whole breast is removed you may feel mutilated. However, you can have breast reconstruction surgery to make your breast look more like your other one.

If you're a 50-year-old woman and your lump is the size of a quarter, then your cancer is fairly small. It can be removed without taking away your whole breast. This would leave your breast looking pretty good, although it may feel different to you.If you want to keep your breast, you need to know that the length of time that you live after being diagnosed with breast cancer does not improve if you have more drastic surgery (for example, by having your whole breast removed). When you weigh your options about what type of surgery to have, you may find that you can't bear the thought of having a large scar and having to think about your cancer every time you get dressed or undressed. You may think that you won't want to have sex anymore if your whole breast is removed. Once you've considered your feelings about the different types of surgery, you may think you would like to have surgery to remove the lump and leave as much of your normal breast tissue as possible (breast-conserving surgery). You should discuss your choices with your doctor, because there may be issues you have not considered. Your preferences will be the key to making the decision that is right for you.