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When You and Your Family Disagree

Posted 7/7/2016

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  Not uncommonly, patients and their families disagree about the best treatment choice. It can happen in the beginning when the initial diagnosis is made. What is the best surgery choice? Who is the best surgeon? Does it matter which hospital s/he operates in? It can come up later when decisions must be made about chemotherapy regimens or even whether or not to take chemotherapy. It most certainly can come up during advanced illness when very painful decisions must be made about whether to continue treatment or to transition to a focus on QOL and hospice care.

  At its most painful, I have seen very hard situations in which the patient is too ill to participate in conversations or choices. Sometimes there is in-fighting within the family and tensions can run very high. This scenario is a very good reason why we should have these conversations with our families far in advance. It can only help if those who love us are clear about our wishes.

  This is all an introduction to a good piece from Cancer Net about these disagreements. I have a  great deal more to say, but am typing at our cottage in Maine where the internet service is very slow. In a quick summary, this happens all too often and the patient should get the trump vote.

  Here is the start of the article and a link to read more:

When You and Your Family Differ on Treatment Choices

A person with cancer may have more than one option for treating the disease. In making this choice, patients often ask for the opinions of family members. In some cases, family members may disagree with each other and with the patient. And this can create conflict when family members need each other's support the most. This can be more complex when the patient is a child or an adult who is medically unable to make decisions. This article provides suggestions on how to communicate and work together to make treatment choices.

Guiding principles

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, consider the patient's viewpoint first. As the person with cancer, you have the right to be heard and have your wishes respected. You also have the right to change your mind. As 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 you disagree, keep communicating with each other and support the patient in his or her choices.

Talk openly about the patient's priorities for treatment. These could range from surviving as long as possible to maintaining a specific quality of life, even if that means stopping treatment. If this is difficult for your family to discuss, ask a doctor, nurse, member of the clergy, social worker, or counselor to facilitate this conversation.

 Barriers to Conversation 

It can be difficult to talk openly about treatment options for many reasons:

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

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

Identify potential barriers and discuss them up front. This will help you get the information, support, and resources you all need to make the best choices.

Read more: http://www.cancer.net/navigating-cancer-care/advanced-cancer/when-you-and-your-family-differ-treatment-choices

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