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DISCUSSION
These are complex questions. As always, understanding the context of the question is vital. When we, as health care providers, are asked difficult questions by our patients and families, to feel that we should have an answer is normal. They look to us because of our experience and expertise to help them decide.
But rather than answer their question with what I believe is the best clinical choice, I answer with a question of my own, with the goal of gathering more information. Because as it turns out in many of these situations, there is no right or wrong answer.
One way to start a dialogue is to acknowledge what a challenging position the patient is in. “Sounds like you are facing a difficult situation. Tell me more about what you think your options are.”
Putting the choice in context is also important. For Mary’s question I might ask, “What does not giving up mean for you today?” And follow up with, “What might it mean for you tomorrow?” The answer may be different. Her answer might be, “I don’t want to give up, but I don’t know how I can keep going this way.” Right away this gives more context. The core of her struggle is linked to feeling physically depleted. Asking for clarification can help our patients by letting them hear, spoken out loud by themselves, how they view their choices. Oddly, we do not need to clarify for them, which is what we may focus on, rather we need to support them so they can clarify it to themselves.
Decision paralysis is more than a struggle with making a decision. It is also a struggle over limited options. A recurring communication challenge for nurses is in listening to, clarifying, and supporting our patients when faced with debilitating decisions.
Ann Brady is a symptom management care coordinator at a cancer center in Pasadena, California.
