Shared decision-making in cancer

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Shared decision-making in cancer
Shared decision-making in cancer

As Oncology Nurse Navigators, we often are faced with helping patients and families make tough decisions about cancer treatment. In my own practice with prostate cancer, there can be several, seemingly equal, effective treatment options, with no true standout. Given our expertise and experience with patients, we are in a prime position to help with decision-making—not to give true medical advice, but perhaps to help patients and families arrive at a well-thought out decision.

Shared Decision Making (SDM) is defined as a collaborative process that allows patients and their providers to make health care decisions together, taking into account the best scientific evidence available, as well as the patient's values and preferences. SDM honors both the provider's expert knowledge and the patient's right to be fully informed of all care options and the potential harms and benefits. Using examples of decision making outside of health care can be a great way to shine a new light on using SDM in our practice.

“Our best decisions are a finely tuned blend of both feeling and reason – and the precise mix depends upon the situation.” (J Lehrer) 

Poker—a science or an art? Successful poker players need to excel both in the rational (mathematical probabilities, odds), as well as the irrational or emotional (trying to gauge the mood and emotion of the other players, or even acting deliberately to affect how the others play and react). A premier poker player—and former physicist!—even says, “As a physicist, it can be hard admitting that you just can't reason your way to the winning hand. But that's the reality of poker. You can't construct a perfect model of it. It's based on a seemingly infinite amount of information. In that sense, poker is a lot like real life.

“The best poker players don't pretend that poker can be solved. They know the game is ultimately a mystery.”

The mystery of prostate cancer Prostate cancer treatment decision-making is also very much a mystery. Men are overwhelmed with seemingly infinite amount of information, in learning about their new diagnosis. The stakes are high here, much higher than in poker, dealing with life itself.

I have had the privilege of helping many men through this decision-making process, including highly intelligent engineers, scientists, and physicians. When they try to approach the decision from a purely rational perspective, it can become a very frustrating drawn out process, drowning in a sea of statistics, with no easy percentages, such as 0% or 100%, anywhere to be found.  

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