Can't Make a Treatment Decision? How to Overcome "Decision Paralysis"

I believe the hardest decision a man makes is when he faces a prostate cancer diagnosis and is asked, "How do you want to proceed?" While many treatments are available, my experience with men suggests the average guy just goes into shell shock and is clueless on what next steps need to be taken.

Due to my work, I easily have met with or spoken with several hundred men over the past 10 years who have faced this decision point. Few know how to respond.

Information overload

One of first of two examples I will mention here was a gentleman who reached out and asked if we could meet for breakfast as he had a “few questions.” When I arrived, he presented me with two three-ring binders each about four inches thick and filled with various internet articles and clippings. I was stunned by the amount of information.

In addition to his research, he also had copies of his medical records, test results, and more that he had collected from four different physicians. I asked where he wanted to start and decided it was best to just sit back and listen. He began the conversation by reviewing every possible negative outcome that could occur with all treatment options.

When he finished some 25 minutes later, I asked if he was offered the option of active surveillance. He said YES. When I asked what the expected outcome of that decision might be, he said not good.

Decision paralysis

I explained with a prostate cancer diagnosis, physicians ask what you want to do. The approach contrasts with a routine visit, where you walk out with a script for a drug or are told go home and rest. The decision approach throws most patients off balance. Unfortunately, the answer for some men is to dive into endless analysis, which can easily lead to decision paralysis.

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I was reminded of the above story recently when yet another patient was referred to me by one of the hospitals. This man apparently has been struggling for several months on how to make a treatment decision. As with my previous referral, he had done considerable research into the outcomes of various treatments and was anxious to give me every negative detail.

At one point he finally paused, took a deep breath, and asked what I would suggest for a treatment. I never offer medical advice but told him I had faced a contained Gleason 9 diagnosis in 2013, and my decision was a total removal of the prostate. I asked if his MD had informed him the consequences of not treating or opting to stay on active surveillance. The MD indicated that he might have two or three years at the most. I asked if he was comfortable with that path. He said no.

A never-ending circle

In both cases, the men understood that inactivity was not the best option. Yet due to an overall lack of knowledge, both found themselves in a never-ending circle of research with no clear solutions, with no end in sight and no predetermined trigger point at which they would be prompted to act. Their future at this point was just to pursue more options and ask more questions.

I have discovered some men who do a deep dive into research are simply engaging in a distracting effort that helps them justify their efforts, while conveniently avoiding the need to act. When I ask men if they want to die most (sadly not all) say, "I want to live." At this point my approach is, "OK call me tomorrow and let me know your decision, because if you continue to do more research you are moving yourself closer and closer to an early death."

As tough as it sounds sometimes, I discovered it is often best to stop encouraging men who are avoiding a decision and ask direct and blunt questions. Typically most men call the next day with their decision. I am happy to report that both men mentioned decided on a treatment path. If you find yourself or someone close to you is caught up in an endless research circle, perhaps what is needed is an up-close reality check.

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