Advance Care Planning

Cancer treatment can be complex and unpredictable. Having an advance care plan helps ensure that your medical care aligns with your values and wishes if you can't speak for yourself. It also eases decision making on your loved ones and may help them feel less burden, guilt and depression.

Advance directives are legal documents that allow you to outline your preferences for medical care if you are too sick to make decisions or communicate your wishes. These documents ensure your health care choices are respected.

Types of Advance Directives

• Living Will: A living will outlines the types of medical treatments you want or don't want if you're terminally ill or permanently unconscious. It can include preferences for life-sustaining treatments like ventilators or feeding tubes.
• Health Care Power of Attorney (HCPOA): This document names a person (a health care proxy) to make medical decisions on your behalf if you're unable to do so. Choose someone you trust to follow your wishes and act in your best interest. Your health care proxy is typically a spouse, an adult child, parent or sibling, but they do not need to be related.

In addition to a living will and a HCPOA, you may want to consider discussing with your physician the preparation of the following documents as well:

• Do Not Resuscitate (DNR) Order: A DNR order is completed with your physician while in the hospital or while in hospice care and tells health care providers not to do CPR (cardiopulmonary resuscitation) if your heart stops or if you stop breathing. You might make this choice because you want to avoid the discomfort or low chance of success associated with CPR, especially if you have a terminal illness or want to focus on comfort at the end of life. It's a personal decision that is part of your planning for end-of-life care.
• Physician Orders for Life-Sustaining Treatment (POLST): POLST allows individuals with serious illnesses to specify their desired medical treatments for end-of-life care. Completed with a doctor, it provides specific instructions on treatments like resuscitation and intubation. Unlike an advance directive, the POLST is a doctor's order and is followed by health care professionals across various settings, ensuring patient wishes are respected, especially in emergencies. However, it may not always be recognized by EMT staff or all medical providers.

How to Create Advance Directives

• Discuss your wishes: Talk with your family, friends and care team about your values and treatment preferences. These conversations can help clarify your wishes and ensure everyone understands your decisions. It can also help your family heal and grieve in a healthier way in an end-of-life event.
• Complete the forms: Obtain the necessary forms for your state. You can get these forms from your doctor, hospital or online. Fill them out carefully, making sure to follow any specific instructions. If you reside in Georgia, you can download Georgia's Advance Directives for Health Care guide and form.
• Sign and witness: Most advance directives need to be signed and witnessed. Some states require notarization. Check your state's requirements to ensure your documents are legally valid. In Georgia, your advance directive does not have to be notarized, but the witnesses do have to be over the age of 18. Witnesses cannot be a member of your care team or someone who may benefit from your death.
• Distribute copies: Give copies of your advance directives to your health care proxy, family members and doctors. Keep the original in a safe but accessible place.

Review and Update Your Directives

It's a good idea to review your advance directives at least once a year, especially if your health or personal circumstances change. Additionally, you should revisit them whenever you experience significant changes in your health, personal circumstances or treatment preferences. Here are some specific times to consider:

• After a new diagnosis: If you receive a new diagnosis or your condition changes, update your directives to reflect your current wishes.
• Major life events: Events like marriage, divorce or the birth of a child can impact your decisions and who you want as your health care proxy.
• Changes in treatment preferences: If your views on certain treatments change, make sure your directives are updated accordingly.