Be Patient With Loved Ones Making Tough Choices, Husband Tells Physicians

October 26, 2009

By George C. Hill, Ph.D.

Throughout Breast Cancer Awareness Month, we have seen and heard many inspiring stories about survivors and received important reminders about early detection through screening mammography. I would like to add to this robust discussion my own experience as a family member impacted by a loved one’s breast cancer diagnosis.

Such a diagnosis presents many challenges, including the need to make many important decisions. What treatment should be taken and where? Whom should we consult?  What are the risks, and are they worth the benefits? As family members, we put all our desires and hopes into what we decide and do, so we can see our loved ones recover and return to their productive and rewarding lives.

But sometimes that does not happen.  Breast cancer – in fact, all cancers – are complex and evasive. Their cures sometimes hide from the best doctors, with no absolutes in treatment.  While discoveries are being made every day, to family members this progress often appears slow and even contradictory. The most advanced therapy may be slow to heal, if at all. And sometimes the passing of our loved one is evident, inevitable, and impending.  Then it becomes necessary to make very difficult end-of-life decisions.

I recently had the opportunity to share with medical students the challenges for a family as they make these decisions.  I emphasized the need for physicians to be prepared to understand what a family faces. For many, like me, end-of-life decision-making is almost as difficult as the loss. How does one maintain quality of life?  What are our loved one’s desires?  What will give them comfort?  What measures should we try?  When should we stop? Am I giving up hope?  One’s culture and beliefs influence the choices that a family makes.  One is often hesitant and unsure.

These decisions can be facilitated by the presence of a living will to guide physicians and family. If it is clear what measures the loved one desires about where and under what circumstances they would like to spend their remaining time, the family is equipped to make their wishes known to the physician at the appropriate time. It is important this be done before a crisis occurs in order to allow for time and thought.

We as family members must recognize that the wishes of the loved ones are important for the physician. It allows our loved one’s care and desires to be performed to their fullest extent.  It is also critical for the physician to know that this information is often difficult to obtain and to show patience when the family is trying to make such difficult choices.  

For our family, we chose hospice care, one of the most important decisions I’ve made in my life. After thoughtful discussion with family and physician, each family must come to a decision that accommodates their individual family circumstances and puts their loved ones first. While the decisions are difficult, end-of-life preparation is essential.

 

Editor’s Note: Dr. Hill is the Levi Watkins Jr. Professor and Associate Dean for Diversity in Medical Education at Vanderbilt University School of Medicine and a Professor in Microbiology and Immunology.  His beloved wife, Dr. Linda P. Hare, died from breast cancer January 2009. This column first appeared in The Tennessean on Sunday, October 25, 2009.

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