A person with cancer may have more than one option on how to treat the disease, and it can be difficult to choose among them. In making this choice, patients often ask for the opinions of family members. And, in some cases, family members may disagree with each other and with the patient on the best choice, creating conflict when they need each other's support the most. This is particularly complex when the patient is a child or an adult medically unable to make decisions. This article provides suggestions on how to keep the lines of communication open and work together to make treatment choices.

Guiding principles

If you are involved in selecting treatment, these guiding principles can help you evaluate the choices:

• Informed decision-making: Does the patient understand the risks of treatment and the potential consequences of their choices?
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• Responsive to the patient's wishes: Are the person with cancer's wishes explicitly stated and being respected?
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• Consistent with personal values: Is this treatment in harmony with the patient's beliefs and values?

In each aspect, the patient's viewpoint is considered first and foremost. If you are a person with cancer, you have the right to be heard, the right to change your mind, and the right to state your wishes and have them respected. If you are a family member, remember that the patient has asked for your view because they respect your opinion, but there may be many factors that lead them to make a different decision. It is important that, even when disagreements occur, to remember to keep communicating with each other and to support the patient in his or her choices.

Barriers to talking about treatment options

The first challenge may be the fact that it can be hard to begin these discussions. There may be many different reasons for finding it difficult to talk openly about treatment options, including:

• Emotions such as sadness, fear, anger, and confusion
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• Family patterns of talking about health care, including differences in how generations communicate
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• Cultural, spiritual, or religious beliefs about health, illness, and death
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• Misconceptions or lack of knowledge about treatment, side effects, and prognosis (chance of recovery)
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• Fear of giving up independence, affecting lifestyle and finances
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• Fatigue/exhaustion from current treatment
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• Denial, or the belief that if you don't talk about it, it isn't really happening
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• Past experiences with cancer and other illness

Once you identify potential barriers and start talking with each other, you can get more information, support, and resources to make the best choice for you.

Continuing to communicate

Making treatment decisions may require many conversations, with doctors and other health-care professionals, and with family and friends. One of the first questions you should ask the oncologist is when the treatment decision needs to be made. Often, a decision is not needed immediately, and this can reduce the level of anxiety of everyone involved in reviewing the various options.

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

Legal considerations

An advance directive is a legal document that tells your health-care team what to do if you are not able to tell them yourself. These can be changed or cancelled if you change your mind about your choices, but you are the only person who can alter them. Regardless of their health, all people should have advance directives, including:

Living Will. This document gives specific instructions about the health care that you do and do not want, and under what circumstances.

Health Care Power of Attorney. This appoints a specific person to act on your behalf when you cannot and to carry out your wishes. This only takes effect when you are unable to make your own decisions.

Special circumstances

State laws vary in determining the age at which a child can make his or her own medical decisions. Most laws factor in the best interests of the child, the ability of the child to make their own decisions, and the ability to understand potential consequences of decisions. Typically, the parents make decisions for a child who is below their state's age limit.

When there is a question of the capacity of an adult to make their own decision, look first for any advance directives indicating the wishes of that person. If there are none, follow the intent of that person's wishes. The person's treatment facility should be able to refer you to a medical ethics committee or palliative care team that can help guide you through the decision-making process. Attorneys and legal-aid clinics can also be helpful in addressing legal concerns.

Support is available

There are several ways to help you and your family avoid or overcome conflicts about treatment. Talk to each other openly, and communicate your wishes. Your health-care team can assist you, both with explaining your preferred treatment choice and for specific strategies on how to move beyond the difference of opinion.

Additional Resources

CancerCare
www.cancercare.org

NCCS Cancer Survival Toolbox
www.cancersurvivaltoolbox.org

National Hospice and Palliative Care Organization
Caring Connections: Planning Ahead
www.caringinfo.org/planningahead

More Information

Coping: Talking About Cancer

Coping: Family Life

Understanding Advance Directives

When Someone You Love Decides to Stop Treatment