Decision Making For The Cancer Patient – My Guiding Philosophy

This article is an insight into my personal philosophy when helping cancer patients make difficult treatment decisions.

Cancer patients and their loved ones are faced with tough choices throughout the course of the disease.

• Should my 75-year-old father take treatment for his lymphoma, or should I just let him be?
• Should I opt for surgery or for radiotherapy to treat my prostate cancer?
• Should I choose breast-conserving surgery or mastectomy for my breast cancer?
• Should I go for adjuvant chemotherapy after my pancreatic cancer operation, or should I just observe?

Sometimes, decision-making is simple, and there is no doubt about the choice to be made. But, many a time, arriving at the right decision is not easy. Theoretically, there may be advantages and disadvantages of each particular choice of treatment. A “cafeteria approach” where the patient is presented with a “basket of choices” and asked to choose among them may not always be helpful to the patient. The other extreme is a “paternalistic approach” where the treating doctor unilaterally decides what is best for their patient.

An important role of a doctor is to help a patient and their family arrive at a decision that is right for them, which may even include getting a second opinion.

Very often, after a detailed discussion with my patients, when I finally lay out the options in front of them, they ask – “Doctor, forget all the pros and cons. Just tell us which option do you advise?”

In the early part of my career, I would be wary of such a question. I may have said – “I can’t make the decision for you”. Or “Let me explain all the facts again, then you can decide”. I would even sometimes feel “I don’t want to make a decision on their behalf, and get blamed if things go wrong.”

Down the years, I have matured enough to understand that the patient is not trying to put me in a fix. It is simply their way of saying “Help me – I don’t know what to do”

Over the last fifteen years, whenever I have mentored my students and junior colleagues, I have tried to imbibe them with this philosophy – whenever you give a choice to a patient or family, think what you would do in their place – and guide them accordingly.

So when someone asks me “What should I do?”, I put myself in their shoes, think hard, and tell them “If I were you, this is what I would do – ”