197Determine the Most Desirable and the Best Alternatives
The patient stated that alternative В is the most desirable option, but alternative A is
the best alternative because it addresses the factors that she has identified as being
most important. To help the patient move forward in her decision-making process,
you could work with her to minimize some of the factors such as suggesting she talk
things over with her husband before making a decision. You could also point out
that she does not need to make the decision quickly.
When using the Danish and D’Augelli model, you should watch for these poten-
tial pitfalls:
- Some decisions will have more than two alternatives. Many patients, however,
will limit their thinking about alternatives (e.g., having a test vs. not having a
test). Deferring testing until a later time might be another option, for example. - While brainstorming factors, patients may jump prematurely to evaluating alter-
natives for the factors. Try to stop them from doing this as it usually prevents
patients from identifying all relevant factors. - Patients may be reluctant to admit to irrational factors. You may need to tenta-
tively suggest some, such as choosing an option that others want the patient
to choose (having genetic test because your doctor suggested this); worrying
about the impact on one’s self-esteem (guilt or shame about possibility of pass-
ing on a genetic mutation); and superstitious beliefs (e.g., testing for a genetic
condition will bring on the disease). - Sometimes more than one alternative will satisfy a given factor, and this may
contribute to the complexity of making a decision. And probably no alternative
will satisfy every important factor. If it did, then the decision would be clear.
When all alternatives present seriously negative consequences, you might talk
with your patient about which option is least risky, as perceived by the patient.
Another strategy is to talk through how your patient could eliminate or reduce
the negative consequences for different factors. This may allow an alternative to
become more desirable. In the above example, discussions with a financial plan-
ner may help alleviate some of the patient’s concerns about financial impact of
the condition if she tests positive (e.g., purchasing long-term care insurance prior
to testing); discussions about protections against insurance/employment discrim-
inations based on genetic information are also appropriate.
7.4 Some Suggestions for Assisting Patients
in Their Decision-Making
Regardless of the decision-making model you use with patients, the following strat-
egies can help you assist them in their process:
- Reassure patients that they have the ability to make the best decision for themselves.
7.4 Some Suggestions for Assisting Patients in Their Decision-Making