Make Good Treatment Decisions

Here are a few resources that can help specifically compare and contrast procedures and treatments for a specific condition or disease. Remember: the purpose of decision aids is to prepare you to have a discussion with your clinicians. They do not substitute for doing so.

Evaluating Your Treatment Options

One way to begin to understand the tradeoffs of different choices is to use a blank decision form to work through a decision you are facing. These forms commonly ask you to describe the options, identify the pros and cons of each, and assign values to them.

The Ottawa Health Research Institute is part of the Ottawa Hospital Research Institute and is affiliated with the University of Ottawa. A Ottawa Personal Decision Guide form which can help people assess their decision making needs, plan the next steps, and track their progress in decision making can be found in an interactive Web-based format or as a PDF file.
http://decisionaid.ohri.ca/decguide.html

The Ottawa Health Research Institute also has the most complete listing of accurate forms that fill in the blanks of the risks and benefits of different treatments for specific diseases.
http://decisionaid.ohri.ca/AZinvent.php

Consumer Reports Health also has a guide to making health decisions.
www.consumerreports.org/health/decision-support/how-to-make-the-best.htm

Finding Treatment Information

MedicineNet.com is a general health information site that also contains short descriptions of common medical procedures. The site is owned and operated by WebMD. The doctors that produce MedicineNet are also the authors of the Webster's New World Medical Dictionary.
http://www.medicinenet.com/procedures_and_tests/article.htm

Mayo Clinic's public health site contains "decision tools" that help you decide what kind of treatment is best for your condition. Videos and slide shows explain several diseases and medical procedures.
www.mayoclinic.com and http://www.mayoclinic.com/health/tests-and-procedures/TestProcedureIndex

US Food and Drug Administration offers information on both drugs and medical devices.
www.fda.gov

Consumer Reports Best Buy Drugs is a new service by Consumers Union with free information comparing various prescription options for specific conditions. Some information is available in Spanish.
www.consumerreports.org/health/best-buy-drugs/index.htm

Harvard Health Publications-Diagnostic Tests is a searchable guide to diagnostic tests such as MRI, spinal taps and catheterization. It provides information about what to expect before, after and during the tests, and what tests might indicate.
www.health.harvard.edu/diagnostic-tests/

National Cancer Institute Physician Data Query (PDQ) has short summaries about different cancers from NCI review treatment, screening and prevention, genetic and alternative and complementary medicine research from over 70 peer-reviewed journals. The summaries are updated monthly and many are available in Spanish. They are freely available at the NCI website or by calling the NCI helpline.
www.cancer.gov/cancertopics/pdq/cancerdatabase
(800) 4-CANCER or (800) 422-6237

The Effective Health Care Program created by the Agency for Healthcare Research and Quality has several guides for patients and consumers based on research on a variety of topics, such as cancer, diabetes, and mental health.
http://effectivehealthcare.ahrq.gov/index.cfm/guides-for-patients-and-consumers/

Getting Second Opinions

The hardest part of seeking a second opinion can sometimes be finding the right words to discuss it with your doctor. Here are a few suggestions on how to get started:

• "Before we start treatment, I'd like to get a second opinion. Will you help me with that?"
• "If you had my type of cancer, who would you see for a second opinion?"
• "I think that I'd like to talk with another doctor to be sure I have all my bases covered."
• "You know, this is a big decision for me and I would like to talk with another expert or two so that I feel completely confident in our treatment plan."
• "My family insists that I get the opinions of a number of specialists before moving forward."

Here are some resources to help you ask for and seek out a second opinion:

US Government Office of Women's Health has an article on getting a second opinion that includes practical advice about finding another doctor and paying for your second opinion.
http://www.womenshealth.gov/tools/secondopinion.cfm

CNN's Empowered Patient Series produced an article about five diagnoses that often call for a second opinion.
http://www.cnn.com/2007/HEALTH/08/30/ep.second.opinion/index.html

Medicare also has a guide for second opinions relevant for patients with and without Medicare.
http://www.medicare.gov/Publications/Pubs/pdf/02173.pdf

Cleveland Clinic's e-Cleveland Clinic provides online second opinions.
http://www.eclevelandclinic.org/productHome.jsp

In order to understand and discuss your possible treatment options, you may need to become more familiar with common medical terms, risk and statistics. Here are some guides to help decipher the information from your doctor or what you are learning online or from others.

Understanding Medical Terms

We're getting health information from a wealth of sources these days-from books, the Internet, trusted friends and—of course—our doctors. But you might be feeling like the old saying, "garbage in, garbage out," still applies. How can you make sense of it all, so that all the information becomes news you can use? Check out these sites below to start decoding what your doctor is saying.

The Medical Library Association has a very simple glossary that translates medical terms into everyday language. It also has a handy guide to the medical shorthand that your doctor might jot down on your prescriptions. The glossary is available in Spanish.
www.mlanet.org/resources/medspeak/index.html

The American Association for Clinical Chemistry has a comprehensive list of lab tests and the terminology associated with these tests.
http://labtestsonline.org/understanding/

Des Moines University offers a Web site full of medical terms related to specific diseases, along with quizzes to test what you've just learned.
www.dmu.edu/medterms

The Nemours Foundation has a medical glossary just for kids. For instance, "acne" is described as "little red bumps on the skin called pimples."
www.kidshealth.org/kid/word/index.html

Understanding Risk Numbers

When you read in the newspaper that a new ulcer drug increases the risk of stomach bleeding by 30 percent, or your doctor hands you a pamphlet that notes the relative risk of men your age developing prostate cancer with a "watch and wait approach," do you end up feeling like it's all a roll of the dice? In medicine, "risk" doesn't mean "risky" — it's a statistically based measure of how certain treatments fare in certain patients with certain conditions. It's math, sure, but it's math that could help you make some significant decisions about the kinds of care you want to pursue. So what do all those numbers really mean?

The following Web resources can help you understand the basics of medical risk. It can be useful to read several of the pages, since each explains the concepts in a slightly different way.

The National Institute on Aging's short article explains what researchers mean by absolute and relative risk, and describes the medical studies used to come up with these numbers.
http://www.nia.nih.gov/NR/rdonlyres/43F218DA-2188-40BC-90CE-7B740E8FA701/10421/Understanding_RiskWhat_Do_Those_Headlines_Really_M.pdf

BreastCancer.org, a nonprofit organization that provides information about breast cancer, has an article about how to understand relative and absolute risk.
http://www.breastcancer.org/risk/understand/abs_v_rel.jsp

Aetna's Intelihealth site talks about the difference between "association and cause", and statistical risk, but also discusses the difference between small, early studies of a treatment and larger studies carried out over several years.
www.intelihealth.com/IH/ihtIH/WSIHWooo/35320/35323/327387.html?d=dmtHMSContent

The GeneticHealth.com maintains a volunteer website that discusses risk using numerous pictures, including the kinds of graphs you might come across in a medical study.
www.genetichealth.com/Risk_Tutorial.shtml

Consumer Reports Health.org has some decision support resources related to how to understand risk, picking the best studies and using research to support your treatment decisions.
http://www.consumerreports.org/health/decision-support/what-is-a-risk.htm

Developing Your Treatment Plan

The Agency for Health Care Research and Quality (AHRQ) provides patient and consumer information on making treatment decisions and developing a treatment plan with your care team.
http://www.ahrq.gov/CONSUMER/diaginf4.htm and http://www.ahrq.gov/CONSUMER/diaginf6.htm

About.com offers more common questions to discuss with your doctor about any treatment plan. Although this post focuses on osteoarthritis, there is also some good general information about working with your doctor on a treatment plan.
http://osteoarthritis.about.com/od/osteoarthritisdiagnosis/a/talk_to_doctor.htm

The Heart Failure Society of America has a guide for Self-Care that includes helpful information on developing a treatment plan.
http://www.heart.org/HEARTORG/Conditions/Diabetes/PreventionTreatmentofDiabetes/Work-with-Your-Health-Care-Team_UCM_313894_Article.jsp

PBS offers basic information on creating a cancer care plan.
http://www.pbs.org/wgbh/takeonestep/cancer/resources-cancer_care_plan.html