Doctors and Patients Work Together for Best Outcome
New research suggests patients make medical decisions in a way that is very different from that of their family members or physicians, says a report in the Journal of General Internal Medicine.
Whether it is cancer or a hypothetical bird flu pandemic, health crises can force people to make tough medical decisions quickly.
"When you're a patient, and you're sick, and you're just trying to absorb all the information and the emotions of a new diagnosis, it's very difficult to grasp the whole story," says study author Brian J. Zikmund-Fisher, at the University of Michigan Medical School.
In that case, he says, "you grab onto one part of the story and lose sight of the whole picture."
So, helping patients imagine what their physician might think of a particular treatment choice, "might be a very good way to help patients get a bigger perspective on decisions they might face," says Zikmund-Fisher.
In the new study, researchers conducted an Internet survey with nearly 2,400 men and women over the age of 21.
Participants were randomly assigned to one of four groups, each of which was asked to imagine facing two medical decisions as if he or she were a different "player" in the health-care setting: either the patient, the patient's physician, a parent making a choice on behalf of their underage boy or girl, or the medical director of the hospital offering treatment.
All the respondents faced two scenarios, each requiring serious medical decisions.
The first involved deciding whether or not to get a new vaccine against a deadly flu.
Participants were told that without the vaccine, there was a 10 percent chance of dying from the flu. However, the vaccine itself - which was based on a weakened version of the flu - also presented a risk of death estimated at 5 percent.
In the second scenario, a similar risk calculus was presented with respect to a slow-growing cancer. The risk of death attached to doing nothing about the cancer had to be weighed against the risk of death linked to chemotherapy.
Zikmund-Fisher found that the choices made when faced with both "stories" varied significantly depending on which "character" was making the decision.
"Patients" were less likely to choose vaccination or chemotherapy than all other scenario participants.
In the "deadly flu pandemic" scenario, just 48 percent of people who imagined themselves as the patient said they would try the vaccine, compared to 57 percent of those deciding for their child, 63 percent who put themselves in the role of vaccinating physician, and 73 percent of people told to act as the medical director of a hospital.
In the "chemotherapy" scenario, the numbers were similar: 60 percent said they would use it if they were the patient, 72 percent chose it for their child, 68 percent said they would advise the treatment to patients as a physician, and 68 percent said they would support use of chemotherapy in this situation if they ran a busy hospital.
Advanced age did appear to play a role in making decisions, the researchers found.
Those 65 and older were much less likely to choose to treat their cancer with chemotherapy than those under 65. By contrast, the elderly were much more likely to get vaccinated against the flu than their younger counterparts.
When asked to describe their emotional state of mind when confronted with these decisions, the authors found that those playing the parental role were the most likely to experience feelings of anxiety, distress, conflict, concern, worry, and responsibility.
"Physicians" were the next highest "emotionally activated" group, followed by "medical directors," and, lastly, "patients."
The researchers concluded that medical professionals were much more likely than patients to go with proactive "survival" choices that involved having treatment.
Why might this be so? According to the researchers, patients appear to juggle many factors when making a decision. Some may be fearful of accepting responsibility for an aggressive treatment choice that might cause more harm than good.
On the other hand, medical professionals appear to be more focused on taking advantage of treatment options - perhaps in order to be able to say they did everything they could to help the patient.
Zikmund-Fisher and his team suggest, therefore, that caregivers and family members play a key role in advising patients - helping them view their choices through a wider lens.
"By taking a step back and putting yourself into someone else's shoes, it can perhaps help," says Zikmund-Fisher.
"It might not always change your decision, but it might help you better understand your situation and make a decision that's more in tune with your overall preferences," he notes.
Dr. Ezekiel Emanuel, chairman of the department of bioethics at the Clinical Center at the National Institutes of Health (NIH), viewed the findings as a wake-up call for physicians. He believes many physicians have perhaps pulled back in recent years from fully participating in the healthcare decisions their patients make.
"It's a warning to doctors that you can't just lay out cafeteria-style options and leave it to the patients," he remarks. "You have to be more engaged. Doctors should absolutely be involved."
"It's critical," says Dr. Emanuel. "And more importantly, doctors shouldn't be hesitant about making recommendations.
"There has been a tendency for doctors to be a little bit resistant about putting forward their opinions because of the increase in patient autonomy over the last 20 years," he says. "And I think that's clearly a mistake."
Always consult your physician for more information. |
The National Cancer Institute (NCI) working with Cancer Care, Inc., prepared the following important fact sheet for persons considering medical treatment.
The NCI says it may seem obvious, but it is very important to remember that you are the most important person on your health care team.
As with any type of health care you receive, you are a consumer of services, and you should not be afraid to ask questions about what services you are getting and who is providing them.
When you are going to meet with a healthcare provider (a physician, nurse, or other healthcare professional), bring someone else with you. It helps to have another person hear what is said and think of questions to ask.
Write out your questions beforehand to make sure you do not forget to discuss anything.
Write down the answers you get, and make sure you understand what you are hearing.
Do not be afraid to ask your questions or ask where you can find more information about what you are discussing. Being well-informed is your most important task as a member of the health care team.
The NCI describes the possible members of a health care team in addition to physicians, including social workers, psychiatrists, psychologists, nurses, dieticians, and clergy.
Social workers are professionally trained in counseling and practical assistance. They provide the broadest range of help to people with cancer, and are a good place to start if you have recently been diagnosed with cancer and unsure of what to do next.
A psychiatrist is a medical doctor who specializes in providing psychotherapy, or general psychological help. A psychiatrist specializes in helping people who are depressed, anxious, or otherwise unable to cope psychologically.
Because they are physicians, psychiatrists can also prescribe medication, such as antidepressants or medication to help you sleep.
A psychologist is also someone who can assist you if you are feeling depressed, anxious, or sad. While not medical doctors, psychologists have obtained a doctoral degree in psychology and counseling; many specialize in marital counseling or chronic illness.
Nurses are an extremely important part of your health care team. Nurses have a wide range of skills, and are usually in charge of actually implementing the plan of care your doctor has set up for you.
Nurses are trained to administer medication and monitor side effects. Whether you are staying in the hospital for care or receive it on an outpatient basis (which means you go home after each treatment), you will benefit from seeking assistance, asking questions, or getting tips and advice from your nurse or nurse practitioner.
Nurses are often aware of support services in your community and can usually provide you with educational materials and pamphlets.
Another form of home care is from a home health aide. Home health aides assist people who are ill and need help moving around, bathing, cooking, or doing household chores.
Some state Medicaid programs will pay for home health aide care, provided they are supervised by a nurse. However, private insurance or managed care plans rarely pay for a home health aide unless there is also a need for skilled nursing care.
Rehabilitation services help people recover from physical changes caused by cancer or cancer treatment. It includes the services of physical therapists, occupational therapists, counselors, speech therapists, and other professionals who help you physically recover from cancer.
Dietary or nutritional counseling or services are commonly prescribed for people with cancer. A dietitian can suggest ways to get enough calories, vitamins, and protein to help you feel better and control your weight, and can give you tips about increasing your appetite if you experience nausea, heartburn, or fatigue from your illness or treatment.
Prayer and spiritual counseling can be very important in coping with a serious illness such as cancer. Many people find it useful to get help from clergy or other spiritual leaders, and there is no question that a strong sense of spirituality can help people face difficult challenges with courage and a sense of hope.
A diagnosis of cancer or other serious medical problem may be the most difficult challenge you or your loved ones will ever face. That is why it is important to find help and try to maintain your sense of hope no matter what your situation. Your team of health care professionals is knowledgeable about the many different aspects of a medical condition: medical, physical, emotional, social, and spiritual.
Always consult your physician for more information. |
