When you learn that you have a specific disease or condition, it can be confusing and overwhelming. There are many resources and sources of support to help you.

After you have learned about treatment options (from your provider and your own research), you need to make a decision about what is best for you.

What should I consider when making treatment decisions?

There are several things you will want to consider when making any treatment decision:

• Risks: What are the risks or problems associated with treatment? Be sure you understand the side effects and potential for complications. Also investigate the financial costs.
  
  
• Benefits: What are the potential benefits? How will the treatment address your problem?
  
  
• Evidence: How much evidence (research or experience) exists? Does it support the efficacy and safety of the treatment?
  

It is often helpful to consider the risks, benefits, and evidence together. For example, you may decide to pursue a course of treatment even if there is only a moderate amount of research for it but the potential benefits are high and the known risks are low.

On the other hand, if the risk of a treatment is high and the benefit and research only moderate, you may not chose to pursue it. Our treatment decision model under the Apply It tab helps you weigh these three factors.

In addition to these factors, there are two other things you might want to consider:

• Is the treatment or therapy compatible with your personal values and preferences?
• Is it accessible at a reasonable cost?

Can you give me some examples?

Joe

After struggling with knee pain for four years, Joe finally made an appointment to see his primary care provider. It was getting difficult to walk up stairs and Joe had to stop playing softball as it was just too difficult to run. An x-ray revealed significant degenerative joint disease.

His nurse practitioner explained that chronic arthritis is quite common over the age of 50. Joe had a couple of options to consider. Eventually, he would likely need surgery – a knee replacement. In the meantime, his nurse practitioner suggested he try taking the herbal supplements glucosamine and chondroitin for 60 days to see if they help.

Joe decided to investigate the pros and cons. He started by contacting his health insurance to find out what it would cover, then went searched the internet for information. He found a recent National Institutes of Health study on a Glucosamine/Chondroitin Arthritis Trial that gave some good evidence.

Category	What Joe Found about Glucosamine/Chondroitin
Risk	Cost risk: Moderate. Health insurance won’t pay for these dietary supplements and they are relatively expensive. Health risk: Low. The risk of side effects and adverse effects is low.
Evidence	Moderate: An NIH study, the Glucosamine/Chondroitin Arthritis Trial, showed efficacy for these dietary supplements for knee and hip osteoarthritis.
Benefit	Good: Studies indicate that these supplements provide pain relief similar to NSAIDs and possible slowing of cartilage damage.

Joe believed that the evidence was encouraging but not definitive. However, the potential benefit was high and the health risk low, so he decided to invest in the glucosamine/chondroitin and see for himself.

Jane

Jane, a college student, had migraine headaches for four years. At first, they lasted only a day or two, but over the past year they have increased in frequency and often last 3-4 days. She saw her primary care provider, who gave her prescriptions for two different medications. After trying the medications for 6 months, Jane was concerned that they were not helping the migraines and were giving her side effects that interfered with her ability to keep up in class and study.

Jane had heard about acupuncture treatments for headaches and wondered if they would be a better option for her.

Category	Prescription Medications	Acupuncture
Risk	Cost risk: Low, since health insurance pays all but $20/month copay. Health risk: Moderate to High. Jane finds the medications interfere with her ability to do study.	Cost risk: Moderate, since Jane will probably have to pay for the treatments herself. Health risk: Low. There are few side effects or adverse events associated with acupuncture.
Evidence	Good. The medications have undergone clinical trials and FDA approval.	Moderate to Good: Found 129 articles on PubMed on acupuncture and migraine headaches.
Benefit	Low: The medications aren’t helping her migraines.	Good: A large 2004 study in the British Medical Journal reported that those in the acupuncture group had fewer headaches and took less medication.

Jane thought that the evidence was moderately strong, but still not definitive. However, it seemed that the risk associated with acupuncture treatments was low, and the benefits high. Since her prescription drugs weren’t giving her relief, she decided to stop taking them and give acupuncture a try.

Are there special considerations for complementary therapies?

If you are considering using a complementary therapy, you will want to do the same analysis as for any treatment, considering the risks, benefits, and evidence. Has it been used successfully to treat the specific condition you have, and does it make sense for you?

Here are a few things to keep in mind with complementary therapies:

• "Natural" does not necessarily mean safe. Some mushrooms are safe and healthy to eat while others are poisonous!
• Not everyone responds the same to treatments. Individual factors need to be considered.
• Remember to discuss your use of complementary therapies or questions you may have with your healthcare provider. Even if there is evidence that a particular complementary therapy in general is safe and effective, it may not be right for you.

Whether you are purchasing a product or seeing a complementary practitioner, know what you are buying

Are there any cautions with using complementary and conventional approaches together?

Realize that conventional and complementary approaches should not always be combined. Consider the following true story. After being on the organ transplant list for three years, Linda was relieved and grateful when the call came that a lung was available. Following the transplant, she would be able to resume many of the daily activities that had become impossible.

As with many patients after transplant, Linda continued to face some significant health challenges and experienced some depression. Linda wondered about taking the herbal medicine St. John's Wort to help and asked the nurse transplant coordinator about it.

The nurse explained that this particular herbal medicine would be very dangerous to take as it interferes with the prescription drug (cyclosporine) that Linda was taking to help her to not reject her newly transplanted lung. In this situation, taking the herbal medicine could have had a very negative impact on Linda’s health.

In summary

When making any treatment decision, you should consider the risks, benefits, and supporting evidence for the treatment. In addition, you should consider if the treatment is compatible with your personal values and preferences and if it is accessible at a reasonable cost.

When considering complementary therapies, use the same analysis and don’t assume that natural means safe.

Expert contributor: Mary Jo Kreitzer, Ph.D., R.N. [0]
Created: October 2006

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