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. Once you have made these decisions and had these conversations, complete the correct legal documents stating your wishes.
The Medical Power of Attorney and the Living Will are legally binding documents. When you can't make decisions for yourself, they state who will make decisions for you and what types of decisions will be made. If you complete these forms before your visit, please bring them with you to the hospital.
The Out-of-Hospital Do-Not-Resuscitate Order (OOHDNR) is also legally binding. It 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 OOHDNR 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.
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 Advance Care Planning forms before coming to MD Anderson, bring them with you to the hospital.