Healthcare Decisions: Making Tough Care Choices
Throughout your life, you’re given decisions and choices to make. Some of these decisions are easy, others about your health can be difficult and take more consideration.
Ogechi Anyaoku, MD, an internal medicine physician with Adventist Medical Group, shares times where you may need to make a tough medical decision, how to handle it and make the right choice for you and your family.
Healthcare has three basic types of interventions for patients who are sick; resolution of the disease, stabilizing a disease and palliative care, which is treatment focused on providing patients relief from pain and other symptoms of a serious illness. All of these can be hard decisions not only for the patient, but their family members as well. While the decisions are not always easy, they are the best choice for the one who is ill. When taking care of a family member or if deciding what to do for a loved one, there are several questions that you can ask to help you work toward a decision:
- What does the patient want?
- what are the patient’s goals of care and are they realistic?
- What is the reason a decision needs to be made?
- What are the options?
- What are the pros and cons for each option?
- What is the length of recovery?
- Where is the information coming from?
- Is there enough information to make an informed decision?
Occasionally, these decisions need to be discussed amongst several people, not just the patient or a healthcare power of attorney. “Planning ahead and telling friends and family what you would like in a situation where care decisions need to be made can help them make decisions in line with your goals and beliefs,” says Dr. Anyaoku. Instances where these healthcare decisions may occur include:
End of life care
End of life care helps doctors and nurses treat you when you’re nearing the end of your life. For many, this includes not taking extraordinary measures. Some people want every possible measure taken to extend their life whereas others just want to enjoy their finals days and be kept comfortable. Talk with your care team and your family to help them understand what treatment, if any, you would want.
Treatments for disease
Treatments for diseases can vary based on the illness. Some of these illnesses have well known and successful treatments while others do not. Based on the disease, decisions need to be made regarding the different treatments available, what they entail and if they are wanted. For some, treatments may not be wanted depending on how far a disease has progressed.
Some illnesses don’t have treatments, or the current treatments have been exhausted and experimental treatments must be used instead. In this case, some of the treatments are in testing phases and have risks that are both known and unknown. You must decide if the risks outweigh the pros of the treatment.
As loved ones like parents, grandparents, aunts and uncles get older, other types of care may need to be implemented. This can include factors like:
- Who will take care of them when they need help or become ill?
- Are they able to stay alone during the day?
- Can they perform their own basic functions such as eating, bathing and grooming?
- Can they live alone?
- If they can’t live alone, where will they live?
- What type of end of life care do they want?
It’s best that as loved ones get older, to discuss what kind of care they want especially if they become ill and are unable to make that decision for themselves.
“Creating an advance directive will make it easier for those making decisions for your care to understand what measures you want taken in certain cases of illness, explains Dr. Anyaoku. An advance directive allows family members to reference this document to assist in managing care. “These options are often used when all other care options have been exhausted and refer to end of life treatments,” she adds. The use of the following might be referenced in an advance directive:
- Hospitalization preferences
- Feeding tubes
- Future treatments
- Palliative care
- Organ donation
It’s best to understand what types of treatments family members would prefer early on since everything can be overwhelming and emotional in the moment. “Knowing what a loved one wants before a situation arises will make it easier to make the decision in the moment since it has already been discussed,” says Dr. Anyaoku. “Talk with loved ones to help you plan what decisions should be made in certain situations.”
Having the Conversation
Discuss with loved ones the type of care you would like to receive and help them understand why you want to receive that type of care. Everyone has their own thoughts about the type of care they want to receive so sharing those wishes with someone else helps them to understand what you want. During the conversation about an advance directive, be sure to cover:
- What you want and don’t want in your care
- Worries or fears about your health
- Worries or fears about the care you’ll receive
- Types of treatments you’re okay and not okay with
“Making healthcare decisions for yourself and others can be difficult. Have the conversation about what you or your family members want in their treatment and care before a situation worsens so everyone is prepared before the time comes,” says Dr. Anyaoku. It’s also important that you respect the choices of your loved one. It may be hard to talk about, but it can also bring you closer together as you and your loved one focus on what’s important to them and their quality of life.