If you became too sick to make your own decisions, what type of medical care would you want? Advance directives allow those with cancer to answer these types of questions while they’re still thinking clearly. Unfortunately, it’s hard to make definite plans without an extensive medical background or a magic crystal ball. After all, who knows where your illness will take you and what type of options will be available at the time. Try to think through various scenarios when you make your advance directive?
Thinking About Your Goals
Ultimately, the purpose of the advance directive is to help you articulate what your goals are. Are you trying to stay alive no matter what? Do you feel that the side effects of chemotherapy currently outweigh the benefits? Do you wish to be with your family as often as possible? The answers to these questions can help guide the choices you make. Don’t feel that your decisions are set in stone, though. As the situation changes, you may want to update your advance directive.
How do your ultimate goals affect your advance directive? If your preference is to stay with your family, the doctor can sign a Do Not Leave Home (DNLH) order that you do not wish to be taken to the hospital. If your comfort is a goal, you might specify that you don’t want a feeding tube. Thinking about your pain and comfort is incredibly important when it comes to advanced cancer.
Things To Consider
Keep in mind, though, that the advance directive only comes into play during the times when you become so seriously ill that you cannot speak for yourself. When the doctors expect that you will recover fully, the advance directive doesn’t apply. For instance, if you were in a car accident and needed immediate attention, the emergency technicians should still bring you to the hospital. This situation doesn’t relate to your cancer, so the advance directive doesn’t apply.
Specifying What You Want
When most people think about advance directives, they’re usually focused on the things that are not wanted in their future care. For instance, they might know that they don’t want to be resuscitated or that they don’t want to spend their finals days in a hospital hooked up to monitoring machines. However, advance directives can also be used to specify the types of things that you do want to happen in your care.
A lot of this relates to the types of things that will make you more comfortable. Some examples of comfort care that you might list in an advanced directive are:
- Medications or other treatment you want for pain or nausea.
- How to address bedsores from lying in the bed so long.
- Any type of spiritual care you desire, such as visits from a clergy member.
- Psychological support for both you and your family.
- Having someone take care of your skin with lotions.
- Keeping mouth and eyes moist when you’re not able to do this yourself.
- Allowing loved ones to visit at any time, even outside of normal visiting hours.
- Relieving muscle stiffness with massage or passive movement exercises.
- Playing your favorite music in the room.
- Plans to donate your organs after death.
- Making arrangements for your body after death.
Some of the things you want to include in your advance directive require the doctor to issue official physician orders, using the right forms. This means that everyone in the medical community will be on the same page about the care that you want.Some examples of physician orders are:
- Allow Visitors Extended Hours (AVEH) order.
- Full Comfort Care Only (FCCO) order.
- Do Not Intubate (DNI) order.
- Do Not Defibrillate (DND) order.
- Do Not Leave Home (DNLH) order.
- Do Not Resuscitate (DNR) order, also called an Allow Natural Death (AND) order.
- Do Not Transfer (DNTransfer) order.
- Inquire About Comfort (IAC) order.
- No Intravenous Lines (NIL) order.
- No Blood Draws (NBD) order.
- No Feeding Tube (NFT) order.
- No Vital Signs (NVS) order.
- Put your thoughts in writing.
Keep in mind that you are able to review these orders at any time. As the cancer progresses, you may find that you want to make changes to the orders. Many people find it helpful to include some personal feelings about the things in the advance directive. This helps others understand why you made the decisions you make.
Types of Available Therapies
Knowing what type of therapies are generally available for patients and their families can help you to make decisions about what to put in your advance directive.Some of most common therapies include:
- Antibiotics—for infections that may not be due to cancer, such as UTIs or bedsore infections.
- Artificial nutrition – using a feeding tube to receive nutrition.
- Chemical code—permits the use of drugs, but not cardiopulmonary resuscitation (CPR), for resuscitation.
- Continuous positive airway pressure/Bilevel positive airway pressure (CPAP/BiPAP)—using an oxygen mask.
- Cardiopulmonary resuscitation—mouth-to-mouth resuscitation.
- Defibrillator or pacemaker—using a device implanted in the patient to help with irregular heartbeats.
- Dialysis—using a machine to act as the kidneys.
- Do Not Resuscitate order—instructions not to perform cardiopulmonary resuscitation if heart or breathing stops
- Feeding tube—nutrition through a tube down your throat.
- Intravenous (IV) fluids—nutrition via fluid through a vein.
- Total parenteral nutrition (TPN)—nutrition delivered through a needle or catheter placed in a vein. Sometimes called hyperalimentation.
- Transfusions—often of blood or blood products.
- Ventilator—breathing machine.