This past week I took one of those social media quizzes to determine whether I’m left-brained or right-brained.  The results indicated that I’m 2/3 left and 1/3 right – no surprise to me or those who know me well.  While I appreciate art and music and all things “creative”, I am a creature of reason and preparation.  I like facts.  I like statistics.  I analyze things from several angles to be sure that I’m considering all the options. Of course, my admiration of facts, statistics and details has certainly not prevented me from making bad decisions on occasion.  In addition to my love of facts, I am also an emotional being.  Through hindsight, I have realized that my bad decisions were almost always made during times of emotional extremes – when I was feeling euphoric over a new relationship or experiencing the death of someone I loved. I have learned that making decisions based solely on my emotional state rarely produced a good outcome.

One of today’s NYTimes’ opinion pieces discussed some reasons that people make bad decisions. Two points in this piece resonated with the literature review I had done in my graduate work on palliative care.  The author suggests that (1) people do not like to, and therefore will not, challenge those whom they believe to be authorities (e.g., doctors, financial advisors, lawyers) and (2) intense emotions, especially anxiety, stress and fear, interfere with our decision-making capacity.

The author also noted that our own optimism is a culprit in bad decision making.  In a nutshell, we tend to ignore “bad news” we might receive and instead focus only on the “good news.”  We look for that one in a million case that ‘proves’ we have a shot too.  Someone has to win the Powerball eventually, right?  (The odds of winning the Powerball are 1 in 175 million yet how many of us still buy that single ticket?) Likewise, someone could be the medical miracle – why not me or my loved one?

An elderly man once told me that he never expected to become totally dependent on his family.  He required help with feeding and bathing and dressing and walking.  He needed help with everything that he had been doing for himself just a few weeks before.   He had lived with heart disease for nearly 30 years before receiving a cancer diagnosis.  His treatments impacted his ability to function without his family’s assistance and he most recently suffered a stroke which took not only his remaining (albeit limited) ability to function, but it stole his independence.   Even with all of these medical conditions and the complications they bring, he never considered the fact that he might become totally dependent.  He remained optimistic that he would manage his conditions and die peacefully in his sleep one night.

The facts are that nearly 50% of American adults live with a progressive chronic illness.  One- quarter of elderly adults (over 60) is living with two or more chronic illnesses (called co-morbidity in the healthcare arena).  As science and technology allow us to live longer, these chronic conditions will require us to examine more facts and consider all options.  Most Americans (nearly 90%), when asked, say they want to die in their homes and be cared for by loved ones.  Many Americans, like the man above, expect to die peacefully in their sleep.  The reality is very different.  During my graduate literature reviews on end-of-life care, I came across these facts:

1. Most of us will die after experiencing a chronic, progressive and ultimately fatal illness.
2. Approximately 80% of deaths will occur under the care of health professionals in some type of healthcare setting (hospital, nursing home, hospice unit).
3. When the time comes to make important end-of-life decisions, approximately 50% of people are incapable of participating in those decisions.
4. When health professionals are uncertain about what decisions to make, the default is to treat [whether you want treatment or not].
5. If health professionals and loved ones have not spoken with a patient about end-of-life issues, they cannot reliably predict what the patient would have chosen and they find the      decision making responsibility burdensome and stressful.

Talking about our fears, examining facts and risks, and sharing hope are equally important pieces of the healthcare conversations that we all need to have.  We may also need to adjust our expectations.  These conversations will be difficult.  They will be emotional.  The process may, at times, be intensely sad.  But, it can also be liberating for those who want to talk about their illness and share their decisions with loved ones.  It can provide opportunities for families and friends to share what’s most important to them.  Examining all the facts (good and bad), through tempered optimism, can alleviate bad decision-making and decrease the feelings of guilt and burden that so often occur when decisions are made for you, by others, in states of anxiety, stress and fear.

Caring Choices can help you work through the anxiety, stress and fear to examine all the facts and make decisions that will be good for you and for those who love you.

(c) 2013 Caring Choices