Goal Setting Throughout Cancer Treatment and Beyond
By Stewart Fleishman, M.D.
Let’s dig a little deeper with regard to goal setting. Goal setting at the start of cancer treatment focuses on living one’s life with cancer. After treatment, when people say that the cancer has “changed them” in some way, they often mean that they look at themselves differently and how they spend their time and energy, as well as how they choose to enjoy what may have otherwise slipped by. Applying those themes at the beginning of treatment is still somewhat the exception. Most of us are frightened and caught unaware when we first find out that we have cancer and are lost in the busy-ness of getting tests, arranging for appointments, and the fear that treatment will not work and we will die. As more and more testing and treatment are done in office visits, not on a hospital admission, that period of time can be many days or weeks. Despite the initial shock and with guidance from veteran patients, it is during that time when the most meaningful self-examination can take place.
The general areas of reflection include, but may not be limited to the following broad areas:
*How much of an investment of immediate quality of life am I willing to make to achieve successful control of the cancer?
*What general approach should my treatment team take for me?
*What have I experienced in my life thus far that can prepare me for the rigors of treatment?
*How active do I want to be in decision-making with my providers?
*How involved do I want my family or close friends in my care?
Quality of Life Investment:Ask yourself: Am I willing to do anything and everything necessary to control my cancer? To extend my life? Am I interested in protecting my quality of life now if I am expected to survive my cancer for _____ months based on reasonable medical certainty (fill-in: 3,6,12,24)? Or am I willing to make an immediate sacrifice in my quality of life to control the cancer and extend my life about equally?
Providers’ General Approach: Should my providers lean more towards optimism, pessimism or realism for decisions that have less medical certainty?
Life Experience until Now:What have I been through before that can help me now? How did I manage (Did I learn as much as I could? Make decisions purely on intuition? Am I a gambler?)
Role in Decision-Making:Do I want to be involved in decision-making when it is possible or defer to the treatment team’s professional judgment? Do I prefer that experienced professionals make most decisions for me? Is it easier for me to make decisions with a lot of detailed information or broad general concepts?
Involvement of Others:How much am I willing to share with close family members or friends? Are they too objective or remote? Will they be too upset to be helpful? Do they always want me to look at things their way? Once they hear that I have cancer, are they assuming treatment will not work based upon old biases and assumptions? Or will they make blanket reassurances that everything will be OK when it may not be?
It is important to remember that the answers to these questions are fluid and evolving. One is not stuck with one way of doing things as a long-term commitment. Over time, and in specific situations, our decision-making preferences and patterns will likely change.
There is little reason to consider personal goals for treatment and beyond only at the end of treatment, based upon its success. Considering your course from the start will help make the time in treatment as well as the time beyond treatment as meaningful as possible.
Once you learn how you will feel during treatment, you will be able to refine these goals and increase their scope to make sure that your time and energy are well-used, even if that use is rest and energy conservation. The next blog entry will highlight some important information and practical suggestions to maintain energy during cancer treatment.
Stewart Fleishman, MD, is the former Director of Cancer Supportive Services at the Continuum Cancer Centers of New York and the Associate Chief Medical Officer of Continuum Hospice Care-Jacob Perlow Hospice. He was actively involved in research focused on quality of life and symptom control in people with cancer, and serves on national committees dedicated to this work. Originally specializing in psychiatry, Dr. Fleishman's practice was focused on pain management, symptom control and palliative care. He is Board Certified in both Hospice and Palliative Medicine and Psychiatry/Neurology.
This article originally appeared on Demoshealth.com.