Advance care planning is an ongoing process of talking about your goals, values and wishes in terms of your health care. You are encouraged to discuss these topics with your family or friends, those who represent you and your health care team.
It helps to have these talks with your family and health care team early so that you may think through your options and identify what is most important to you about your future health care. In the event that your family or doctor needs to make choices when you are ill, they can do so with confidence that they are following your wishes.
How can I make my health care preferences known?
Whether you're a patient or caregiver, having conversations about future care should be part of your cancer treatment planning process at every stage. It should start at the time of diagnosis.
By preparing for your future, you can ensure your choices are given the utmost respect. Here are some steps for implementing the advance care planning process in your specific medical situation. This serves as a good starting point for patients and families.
Evaluate quality of life. Begin to think about what quality of life means to you. Ask yourself how you want to live. What is important for you to continue being able to do during your treatment or if you become seriously ill?
Have a conversation with your loved ones. Discuss your thoughts with the people who would be involved in making decisions for you if you aren't able to make them yourself. This will ensure that care choices support the quality of life you'd like.
Identify a loved one who can make decisions. Which person in your life do you trust to understand what quality of life means to you? Will this person be able to make these decisions if you aren't able to make them yourself?
Make sure this person is willing to make decisions for you if needed and that he or she knows what's important to you in your care choices. Don't assume anything.
Talk with your health care provider. Once you have defined your own terms for quality of life and identified someone to carry out your wishes, discuss this with your health care provider. Your physician will be able to provide the medical perspective of your situation and your wishes.
Discussing this with your doctor informs him or her about what treatment options you would or wouldn't want down the road.
Complete the paperwork. Completing advance directives
is one way for you to make your wishes known about medical treatment before you need such care. There are three kinds of advance directives:
Medical Power of Attorney: This form allows you to appoint someone you trust to be your agent. The person you appoint makes health care choices for you only if you are unable to do so for yourself.
Living Will: This form allows you to tell people what treatments you would like to have and which ones you want to avoid if you are in a certain health situation.
Out-of-Hospital Do Not Resuscitate (OOHDNR) Order for Adults: This form instructs paramedics, doctors and other health care professionals to refrain from performing cardiopulmonary resuscitation (CPR) when the heart and/or lungs stop working.
After talking with their physicians, some people decide they do not want CPR either because it is unlikely to work or because it does not fit with their goals. The OHDNR only applies outside the hospital. If you are admitted to the hospital and do not wish to have CPR, let your doctor know. He or she can write an inpatient DNR order that applies throughout your stay.
If you decide that either type of DNR order is right for you, it is important to remember that all efforts directed at your comfort will always continue, as will all other medical care that you and your doctor think is appropriate.
Speak with your Social Work Counselor about other Advance Care Planning documents you might want to consider:
- Durable Power of Attorney
- Last will and testament
- Appointment of agent to control disposition of remains
- Organ donation
You do not need a lawyer to complete these forms. Once completed, you will be asked for a copy to include in your medical record so that your health care team may better communicate your wishes to the medical team.
Adjust as your medical condition changes. Just because you make these important decisions at the beginning of your disease doesn't mean you can't change your mind later. Don’t hesitate to re-evaluate your treatment goals as needed.
To learn more about advance directives, the advance care planning process or to speak with someone about your end of life concerns, contact the Department of Social Work at 713-792-6195, tell your nurse or doctor that you'd like to speak with a social work counselor.
If you've completed any Advance Care Planning documents before coming to MD Anderson, please bring them with you.