24 -WHAT DECISIONS NEED TO BE MADE AND HOW TO MAKE THEM

 When it seems that cancer is taking everything from you, you still have choices to make: critical decisions that will ultimately determine the length and quality of your life.  You better make them well. You will need to make them again and again every time there is a change in disease behavior or treatment. Therefore, it is essential to understand the decision-making process.

The doctor will have tough decisions to make, but  so will you. They will focus on the biologic necessities and consequences of any treatment decision. They will gather all the information from your exam and tests, but the right and best decisions will only be possible with your active participation. The physician will attempt to figure it all out, but you must guide him.

 When cancer cannot be cured and becomes chronic and ultimately life-threatening, the personal, social and spiritual arenas become ever more important, and only you can identify them. However, as the specter of advancing disease consumes ever more attention, these are often undervalued or overlooked by the doctors unless you make a point of prioritizing them. If you haven't made a point of figuring out what is of greatest meaning and importance to you, relationships, avocations, work or spiritual journey, and also communicated it repeatedly to your physician, you will be treated like an automaton characterized only by laboratory data and physical exam findings.

At the outset, meaning, purpose, and priorities are almost universally condensed into "keep me alive, Doc." But the further you get in your cancer experience and the further you get on your bell lap, the more other priorities will become apparent and need expression. Treatment should not be "one-size-fits-all," but it will become so unless you are continuously and actively involved.

CRITICAL DECISION PATHWAY

Whether you choose to relinquish decision-making entirely to your physician, or whether you choose to be intimately involved, or whether you choose to involve God, it is useful to understand the human decision- making process.

Neuroscientists have learned that there is an anatomic area of the brain that is absolutely necessary for decision-making called the prefrontal cortex. It functions like a workbench where we place all the components of the problem that needs solving. There we sort them out, prioritize them and craft a solution. It is functionally called our "working memory." The more clutter that is placed on the bench the slower the decision-making process and the more likely an irrelevant decision will be reached.

 Each individual will be faced with a complex array of new and ever-changing information which must be either selected and integrated or discarded from the bench. Few decisions in cancer are urgent (remember that), although they all feel emergent. But if you put off making decisions you risk overloading your workbench and decision-making circuitry, which may lead ultimately to poor decisions. Take all the time you need but be disciplined and expeditious to avoid becoming either forgetful or frantic.

More important than speed in decision making is identifying and focusing on the critical pieces of information and your specific goals. Only after distinguishing between what is possible, what is probable and what is hoped for should you then decide on a course of action. You don’t ever need to let go of what is hoped for, but you must not let it blind you. Again, walk through your decisions with both shoes on.