At Rocky Mountain Cancer Centers, patients can be surprised when their doctor recommends talking with our social workers about advance care planning. Often, patients – or their caregivers – may jump to the conclusion that they are not going to survive their cancer.
However, that’s not the case.
At Rocky Mountain Cancer Centers, we recommend that all patients create an advance care plan. Even when treatment is expected to be curative, the planning helps the cancer team incorporate individual goals and desires into the treatment plan.
Here, Jill Mitchell, PhD, LCSW, OSW-C, answers some common questions about advance care planning.
Q: What is advance care planning?
A: Advance care planning is the process of considering, determining, and documenting what type of care you want at the end of your life. It often starts with thinking about what your values for care are and what quality of life means to you. You also will need to consider who you want to carry out your wishes should you be unable to communicate those yourself. An important part of the process is talking with your family members to hear their concerns and communicate your own desires. Our social workers at Rocky Mountain Cancer Centers are trained in helping to facilitate this process and support your conversations based on the values that are important to you.
Q: What are advanced directives?
A: Advance directives are documents that allow you to designate your wishes for what type of care you would want to receive, and also who should make decisions on your behalf if you are unable to voice your own decisions. These documents – and the conversations you have with your loved ones – help to clearly outline your wishes.
Three primary advance directives to consider creating include:
- Medical durable power of attorney (MDPoA): This document names your health care agent who will be the person who will make decisions if you are unable to voice your own decisions.
- Living will: This document helps you specify more details about the kinds of care you would or would not want at the end of your life and it can serve as a very important guide for your health care agent.
- Medical Order Scope of Treatment (MOST) or CPR directive: These documents are generally recommended when someone has a very advanced illness or are nearing the end of their life. The MOST or CPR directive are medical orders that allow you to designate your wishes regarding the use of specific medical interventions (such as resuscitation, intubation, or artificial nutrition or hydration). These are the forms your doctor or advance practice provider would need to review with you and sign. You do not need to fill these out if you wish for all interventions to be provided.
Q: How does Rocky Mountain Cancer Centers offer advance care planning?
A: Every patient at Rocky Mountain Cancer Centers is offered the opportunity to work with our specially trained social workers and advanced practice providers to engage in advance care planning. We are proud to offer advance care planning services through The US Oncology Network My Choices, My Wishes® program. This comprehensive program helps you explore and document your healthcare preferences in a supportive environment.
Specially trained counselors will help you define the values, activities, relationships and healthcare goals that are important to you, and then complete advance directive documentation that matches your preferences for care.
Q: Who needs to think about advance care planning and when?
A: No one wants to think about end-of-life medical decisions, but everyone should. We encourage all adults at any age or health condition to put advance directives in place—the sooner, the better. In fact, many family members of patients also choose to complete advance directives at the same time as patients.
Most people plan to wait until they think they will need advance directives. Unfortunately, none of us ever knows what can happen tomorrow and when you will need these documents.
We also have experienced that it is sometimes easier for patients and their family members to have these discussions when advance directives are not needed because it is less emotional.
Q: Who should participate in a patient’s advance care planning?
A: This is an individual decision. There are two groups of loved ones to consider—those you want to participate in the decision-making process and those you want to communicate with after you have made your decision. You may want to consult parents, spouses, or adult children as you make decisions about your wishes or you may want to limit involvement. Once you have completed your advance care planning and directives, we recommend communicating your wishes to all family members and close friends, and providing copies of your directives to your designated representatives and to all of your medical providers. It’s important not just to tell family members your wishes, but also make sure they know who has been appointed as your representative and that legal documents are in place.
Q: What happens if I don’t have advance directives?
A: Please know that your spouse or closest family is NOT automatically able to serve as a medical decision maker on your behalf. Unless you officially specify a health care agent to make health decisions on your behalf, a proxy must be selected by a panel of the interested parties in your life, including family, friends, or close advisers. If they can’t agree, it goes to the courts. Also, without clarification about what kind of care you would or wouldn’t want (in the form of a Living Will and MOST or CPR directive), you could endure invasive medical treatments at the end of life that would offer limited, if any, benefit and have the potential to prolong suffering.
Q: Where can I go for more information?
A: Contact your Rocky Mountain Cancer Centers office and ask to speak to your social worker about advance care planning. Colorado Advance Directives Consortium also has a great website full of information and free downloadable forms at: http://coloradoadvancedirectives.com/
