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that helps her recognize her moral responsibility to a sibling, even if the rela-
tionship is poor.
- Explore differences in opinions and attitudes when your patient is a couple or
family (Schoeffel et al. 2018 ; Van Spijker 1992). Go around the group, and ask
each individual to express what she/he thinks and feels about each option. - Recognize and incorporate cultural variables in the decision-making process. For
instance, for some Korean and Arab families, it is important to involve the fathers
as they are the decision-makers (Awwad et al. 2008 ; Brown 1997 ). Cura ( 2015 )
states that “...the Philippine society focuses more on collectivistic rules. In addi-
tion to personal freedom and rights, social harmony, interpersonal concerns and
sanctity are equally emphasized...” (p. 216). He recommends that with Filipino
patients you should “assess other key persons in decision-making by noting who
accompanies a patient during the clinic visit [and]...questions such as ‘Who
should we talk to? ‘or ‘Who can help in making decisions about your treatment
(or decisions) in the future?’ can yield valuable information...[about] key per-
sons in the family, and whose opinions would influence the other individuals’
decisions, especially for patients who are considered as ‘dependents’ in a fam-
ily...[as well as help the counselor] to clearly identify with whom information
should also be shared...” (p. 216). - Explore patients’ experiences of living with affected family members.
- Let patients know that sometimes the most emotionally painful decisions are the
right ones for them. The best decision is not necessarily the easiest to make (cf.
Anonymous 2008). - Suggest that patients listen to their instincts. Often our subconscious is a source
of good advice. This may be particularly helpful for patients who are intellectual-
izing their situation, that is, spending all their time thinking things through with-
out acknowledging how they feel about different options. - Encourage patients to seek support and guidance from significant others (e.g.,
family members, friends, community leaders). - Consider using decision aids or tools to facilitate patient decision-making [for
examples, see Birch et al. (2016) and Wakefield et al. ( 2007 )]. - Engage in anticipatory guidance:
- Use scenarios to help patients evaluate options. As noted by Myring et al.
( 2011 ) in their work with couples at risk for having a child with CF, “...
decision-making often involved scenario-based thinking. This was reported
by participants of both sexes but described more vividly by the women in this
study. This process typically began during the adaptation phase and eventu-
ally formed a base for decision-making. Women described how they thought
through all possible scenarios, including raising a child with CF and the
potential impact on the family unit. Personal experience with CF was also
central to this process. For individuals with a child with CF, the potential
effect of their decisions on their affected child was extremely important in
their considerations” (p. 409).
- Use scenarios to help patients evaluate options. As noted by Myring et al.
7.4 Some Suggestions for Assisting Patients in Their Decision-Making