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 caregivers, friends, those who represent you, and your health care team.
It helps to have these talks with your caregivers and health care team early so that you can think through your options and identify what is most important to you. In the event that your caregiver 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 your care and the future should be part of your normal routine. If you haven't had these conversations, they should start at diagnosis and be revisited through every phase of treatment.
Here are some steps for implementing the advance care planning process:
Evaluate quality of life. 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 throughout 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? 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, review all of it with your health care provider. Doing so will inform your doctor about what treatment options you would or wouldn't want down the road, and allows your doctor to provide medical input and perspective.
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 in Texas:
Medical Power of Attorney: This form allows you to appoint someone you trust to make health care choices for you if you are unable to do so for yourself.
Living Will: This form allows you to tell people what kind of medical care you would like to have or avoid if you cannot speak for yourself.
Out-of-Hospital Do Not Resuscitate (OOHDNR) Order for Adults: An order signed by a doctor allowing you to refuse life-sustaining treatments when outside the hospital. If you are admitted to the hospital and do not wish to have life-sustaining treatments, let your doctor know so an inpatient DNR order can be signed for the duration of your stay.
In collaboration 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 care goals. 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
- Appointment for 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 wishes can be communicated to the medical team.
The Department of Social Work also has an advance care planning workbook that will guide you through the process, and help you think through the types of care you would like to receive at every stage of your treatment.
Adjust as your medical condition changes. Advance care planning is an ongoing process. You can always change your mind and re-evaluate your treatment goals as needed.
To learn more about advance directives, the advance care planning process or to speak with someone about end-of-life concerns, contact the Department of Social Work at 713-792-6195, or tell your nurse or doctor that you'd like to speak with a social work counselor.
When you hear the word cancer, you begin to contemplate the finality of life and ask yourself a hundred questions: Will I survive? If treatment is no longer an option, how do I want to spend my remaining time? What if I am no longer able to make my own decisions? How do I choose someone to speak on my behalf?
I’m thankful my cancer journey has not reached a point when those last questions mattered, but when I was just beginning my breast cancer treatment, I didn’t know what was going to happen. Thankfully, advance care planning helped me prepare for every scenario.
Establishing clarity with MD Anderson and my family
After my breast cancer diagnosis, I really took the time to understand my disease, prognosis, as well as my treatment goals and plans. That information allowed me to openly discuss all my options with my family and health care team, and choose the treatment course that best fit my needs. And because I had already completed my Medical Power of Attorney, Living Will and Out of Hospital Do Not Resuscitate Order, MD Anderson knew from the get-go who could speak on my behalf if I was no longer able to do so and what my medical team needed to do in emergency and life-or-death situations.
Taking control of my medical decisions
Making my care preferences known early got everyone on the same page and lessened my anxiety about the future. When I was being wheeled into surgery, someone asked me if I’d already completed my advance directive forms. I was glad my answer was yes because I didn’t have the added pressure of thinking about those questions.
Advance care planning also gave me the opportunity to remain in control of my care. So if I’d somehow lost the ability to convey my thoughts after surgery or during one my chemotherapy treatments, it felt good knowing that my family and care team could still execute my wishes. Plus, it also protected my family from having to make any of those unbearably difficult decisions on my behalf.
How advance directives can make your cancer journey easier
I know talking about advance care planning during cancer treatment can be frightening, and it can generate a lot of emotions. However, I believe that it can empower us to become involved in making decisions about our care. It can help us avoid undesired medical treatment, stress in a time of crisis, and lessen the financial and emotional burdens on our loved ones.
I recommend documenting those decisions at the start of treatment, before the possibility of unforeseen circumstances even exists. Doing so helped me thoughtfully choose the care I really wanted and gave me some sense of control in my cancer journey. It can help do the same for you, too.
If you are interested in learning more about advance care planning and/or advance directives, please call the Department of Social Work at 713-792-6195.
Request an appointment at MD Anderson online or by calling 1-877-632-6789.