Guest guest Posted November 5, 2008 Report Share Posted November 5, 2008 http://besttreatments.bmj.com/btuk/howtouse/130.jsp Shared decision-making: working with your doctor In this section Key points about making decisions with your doctor Don't be afraid to ask questions Your values count Learning to deal with uncertainty Key points about making decisions with your doctor Even with the best evidence from research, no one can tell you what treatment is best for you. It's OK to ask your doctor questions. You may find it helpful to take a friend with you when you go to see your doctor or to write down questions before your visit. You should ask your doctor what the research says about treatments for your condition. You should ask whether researchers studied people like you (for example, were they the same age). Sometimes no one knows what the best treatment is for a disease. Ideally, you and your doctor can work together to make a decision about your treatment. Your doctor can help you decide which is the best treatment for you. For more help, see How to make the best decisions about treatment. Here are some things to remember when talking to your doctor about your condition and the choices for treatment: You shouldn't be afraid to ask questions Your feelings about treatment counts You may need to make decisions about treatment without being certain about what will happen Don't be afraid to ask questions Many people find it hard to ask their doctor questions. Sometimes their doctor doesn't encourage them. Doctors always seem so busy. You may worry you will look stupid if you use the wrong words. Or you may worry that you will annoy your doctor by asking questions. Sometimes you may feel too ill to take an active role in making decisions. And some people are happy just to do what their doctor tells them. You may feel more comfortable talking things over with your doctor if you do some of the following things: Write down a list of questions to take with you when you go to see your doctor Have a family member or friend come with you to the appointment Make notes of what your doctor says during your visit At the end of the appointment make sure you know what your doctor has discussed with you and what should happen next. You can say something like, " I just want to make sure I've understood what you've told me. " Or if you are not sure, try saying, " Could you please run through what you said to me again so I can be sure I understand it? " Don't be embarrassed to write down medical terms and ask your doctor how to spell them A doctor who is good at making decisions with you will: Use the best research evidence Share the evidence with you and help you understand it Encourage you to say what matters to you. Many doctors encourage their patients to ask questions, and encourage them to play an active part in deciding about their own health care. For each of the conditions we've looked at, we've given you some ideas of the questions you might want to ask your doctor. Questions to ask your doctor about treatments Do I need to take medicine? Will I get better without any treatment? What are my other choices for treatment? What does this drug do? How long should I use it? What are the benefits and side effects of this treatment? Is there anything I can do to avoid side effects? Can I take this medicine with the other drugs I'm taking? When should I stop taking this drug? When should we talk about whether I need to keep taking it? What should I do if I miss a dose? What else can I do to help myself get better? How to talk about the evidence When you discuss the research with your doctor, ask him or her if the people who were included in the studies are like you. Many studies, for example, do not include women or children or people with more than one medical problem.1 You also can't assume that the results of a study will apply to your situation. For instance, beta-blockers may not be as good as tablets that make your body lose water (diuretics) for lowering your blood pressure if you are black.2 A treatment that may help someone who has a high risk of getting a disease may not help someone who has only a low risk. If you have a high risk of dying from heart disease, you will get more benefit from taking drugs to lower your cholesterol (if you have high cholesterol) than someone who does not have heart disease.3 Studies show that to save one life, 30 people who have a high risk might need to be treated for five years with drugs to lower their cholesterol.3 But 300 people with a low risk would need to be treated before one life was saved. Questions to ask your doctor about studies Does the study give me information about what I'm interested in? Does it cover the risks and benefits of treatment? Does it have people like me in it? Does it compare treatment with other suitable choices? Is the evidence reliable? Your values count Just because the research says that a treatment works doesn't mean you have to have that treatment. You need to make a decision that's based on both the evidence and your personal preferences and values. Here is an example of how some people prefer not to do what the evidence suggests could be helpful. If you have the type of irregular heartbeat that is known as an atrial fibrillation, you are more likely to have a stroke. There are two main types of stroke. One happens when the blood supply to your brain is blocked, and the other happens when there is bleeding into your brain. Randomised controlled trials show that taking a drug called warfarin, which thins the blood, will reduce your risk of getting the first kind of stroke. However, it increases the risk of getting the second type of stroke because it makes your blood thinner. For some people, the chance of getting a benefit from warfarin treatment outweighs the risk of the harm. Yet many studies show that some people who would benefit from taking warfarin refuse to take it. Even when they understand that the benefits outweigh the risks for them, they still do not want to take it.4 Sometimes people want to have a treatment even if there is no research to show it works. People who have life-threatening conditions such as cancer may feel they want to try anything.5 Learning to deal with uncertainty Sometimes no one knows what the best treatment is for you. People often don't realise that there is a lot of uncertainty in medicine. Not every question about treatment has a clear answer. Even when there is good research that shows that a drug works, the drug may work better for some people than for others. Everyone is an individual and will respond differently to treatment. And there are sometimes no clear answers about screening. It isn't clear whether healthy men should be screened for early signs of prostate cancer as they get older. In this case, screening means testing to see if they have raised levels of a chemical called PSA (prostate-specific antigen) in their blood.6 Not all men with high levels of PSA will have cancer. Of those who do have cancer, some will benefit from treatment but some will get serious complications from it. These complications may include problems in having erections. In some men, their cancer may grow so slowly that they will die from something else, not the prostate cancer. The problem is that no one knows which cancers will grow fast and need treatment and which will grow so slowly that they will not be a problem. There is not enough good evidence to know if screening for prostate cancer does more good than harm. In this type of situation it is best if you and your doctor make the decision together. To deal with this uncertainty, some people decide to join research studies that are looking for answers to the questions for which the evidence is unclear. Sometimes charities fund this kind of medical research. You could try contacting a charity that focuses on your condition to see if they know about any research projects. Sources for the information on this page: Tudor HJ. Hypertension guidelines: other diseases complicate management. British Medical Journal. 1993; 306: 1337. Veterans Administration ative Study Group on Antihypertensive agents. Comparison of propranolol and hydrochlorothiazide for the initial treatment of hypertension. I. Results of short-term titration with emphasis on racial differences in response. Journal of the American Medical Association; 248: 1996-2003. GD, Song F, et al. Cholesterol lowering and mortality: the importance of considering initial level of risk. BMJ. 1993; 306: 1367-1373. Protheroe J, Fahey T, et al. The impact of patients' preferences on the treatment of atrial fibrillation: observational study of patient based decision analysis. BMJ. 2000; 320: 1380-1384. Crocetti E, Crotti N, Feltrin A, et al. The use of complementary therapies by breast cancer patients attending conventional treatment. European Journal of Cancer. 1998; 34: 324-328. Yamey G, Wilkes M. Prostate cancer screening: is it worth the pain? San Francisco Chronicle. January 18, 2002: 29. Quote Link to comment Share on other sites More sharing options...
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