Before you read any further, stop and ask yourself, “How many choices have I made so far today?” I bet, from the time you got out of bed, you can easily name 25, including things like what you ate for breakfast, what you decided to wear today, what to listen to in the car, whether to respond to a cousin’s text message right away, etc. Ready for a shock? According to one source, adults make as many as 35,000 decision each day! And yet, in many instances, we’re not even aware of it.

In 20017, an interesting paper on eating choices and how mindlessly we make them was published by Brian Wansink and Jeffery Sobal (Cornell University). According to their analysis, the average adult makes over 220 food decisions per day. After conducting various eating experiments, the authors concluded, “First, we are aware of only a fraction of the food decisions we make. Second, we are either unaware of how our environment influences these decisions or we are unwilling to acknowledge it.”^[i]

Does that sound far-fetched? Take this experiment for instance. Subjects were served food in an exaggerated way, that is, given a large bowl and spoon. As a result, on average they ate 31% more food than they normally would, yet 52% denied they had eaten more, and 45% attributed it to other reasons, such as hunger. They were unaware that environmental factors like the size of the serving ware and utensils had influenced their eating behavior.

Consciously choosing a prostate cancer treatment

Eating is an ordinary activity. It doesn’t take much thought because of habits we’ve formed. On the other hand, sooner or later each of us will face infrequent but significant decisions that will impact our present and future. Every day I work with patients newly diagnosed with prostate cancer (PCa) who have the hugely important task of choosing which treatment to have.

Such a decision is anything but unconscious! In fact, the patient will spend considerable time in pondering, discussing, researching, and emotionally anguishing over the “right” one for him. If he is asked what will influence his choice, he might point to his doctor’s recommendation, or a friend’s bad experience after a particular surgical treatment, or statistics he read about treatment side effects, or what his wife prefers, etc. He deliberately and consciously becomes aware of his personal cost-benefit perceptions that influence his decision.

3 less conscious but powerful influences

Some influences, however, may not be as evident to him, yet they can be profound. I recently came across a small but thought-provoking journal article on environmental influences that a patient may not realize play a role in his choice. According to the authors from several respected academic centers from
coast-to-coast, a patient’s ethnic, racial and cultural context may have a large but unconscious impact on his choices. The team writes, “Factors that influence prostate cancer treatment decisions are complex, multifaceted, and personal, and may vary by race/ethnicity.”^[ii]

The study population was racially and ethnically diverse. Participants were patients with low or very-low risk PCa, all of whom had been treated or decided to be on Active Surveillance—their decisions had been made. They were then interviewed, and the content was transcribed, coded, and analyzed “to identify themes salient for decision-making, with attention to sociocultural differences.”

The authors identified three areas in which racial/ethnic differences played a part in patient decision making, whether or not the men were aware of it:

1. Cultural values differ in how boys develop a masculine identity (e.g., being “macho” is more emphasized in some cultures than others). As adults, how a man was socialized in his maleness can impact his feelings about one treatment approach over another.
2. Religion and spirituality were influences that helped some men on Active Surveillance cope with anxiety, allowing them to adhere to a protocol they might otherwise have rejected.
3. Men who were in a racial or ethnic minority group may have been influenced by historic and social experiences with the healthcare system, thus affecting their decisions.

I’m glad that the research team pursued this line of inquiry. For them, it confirmed that when a patient is wrestling with a treatment decision, pervasive but often subtle factors in his lifelong environment may be as deeply influential as things like side effect statistics—though he may not even be aware of them. The authors also hope their work will “provide some guidance for future research.”

For me personally, it helps me be more sensitive to the diversity of my patients and their backgrounds. In my discussions with them, the three areas above may never come up in their conscious conversation with me, but just knowing that one or more may be guiding a patient’s choice may make a difference in
my empathy toward him. Helping him be aware of all the reasons for his decision—including the deeper ones—may serve to affirm confidence in his choice.

NOTE: This content is solely for purposes of information and does not substitute for diagnostic or medical advice. Talk to your doctor if you are experiencing pelvic pain, or have any other health concerns or questions of a personal medical nature.

[i] Wansink, Brian and Jeffery Sobal. “Mindless Eating: The 200 Daily Food Decisions We Overlook,” Environment and Behavior. 2007 Jan. 39;1:106-123.
[ii] Guan A, Shim JK, Allen L, Kuo MC et al. Factors that influence treatment decisions: A qualitative study of racially and ethnically diverse patients with low- and very-low risk prostate cancer. Cancer Med. 2022 Nov 20.