Care planning

People with terminal cancer can make decisions about their future care. 

Advance care planning

Your doctors and nurses might talk to you about advance care planning. This means making decisions about how you would like to be cared for if you become too ill to communicate your wishes in the future.

The doctor or nurse will write down your wishes. You can let them know at any time if these change. 

There is no set way to plan ahead. You might find it helpful to talk through what’s best with one of your healthcare team. You can also talk about it with someone you are close to. And you can include your family and friends in the discussions with your doctors and nurses if you want to.

Living wills, advance decisions and advance statements

Many people make a living will when they know that they will die.

This is in case a time comes when you can no longer make decisions or communicate your needs. You can only make a living will when you are mentally able. So you have to do it before you need it.

Having it prepared can be reassuring for your next of kin and the health professionals involved in your care. They will only be able to use it if you lose the ability to make decisions for yourself. For example, if you are unconscious.

There are two types of living will. These are an:

• Advance Decision
• Advance Statement

Advance Decisions (Advance Directive in Scotland)

An Advance Decision (in England and Wales) is a set of instructions for your doctors and nurses if you can’t make decisions yourself. This is called an Advance Directive in Scotland. In Northern Ireland, you can make decisions about your treatment and care with the help of your doctor. This includes the right to refuse any medical treatment. Depending on which country you live in, this may or may not be a legal document.

This document ensures that everyone knows what treatments you don’t want or which treatments you would like to stop. As long as you can make a decision, you can refuse treatment for any reason, even if this might lead to you dying. But you can't insist that doctors give you a particular treatment.

You can discuss your wishes and preferences with your doctor or nurse and your family. They can help you decide when your advance decision to refuse treatment would apply.

For example, you might decide that if your heart stopped beating, you wouldn’t want anyone to try and restart it.

You can read more about Advance Decisions on the Compassion in Dying Website. They have an Advance Decision Pack that you can download. 

This includes a form to record any treatments you do not want to be given. This is only used if you become unable to make or communicate decisions in the future. It also includes guidance to help you fill out the form. 

Advance Statements

An Advance Statement allows you to write down your wishes and preferences for the last year or months of your life. For example, you can state what treatment or care you would like to receive. It can cover personal preferences and religious instructions. It can also include non medical information, such as the type of food you prefer, or your religious beliefs.

It isn't legally binding but doctors and nurses should take account of it.

There are different documents available to help you write down your wishes. Some hospitals have developed their own form. Ask your team about an Advance Statement, they can also help you complete it. 

Lasting Power of Attorney

You might want to think about who will manage your financial affairs if you become unable to do this for yourself. This is called Lasting Power of Attorney.

The person you choose to make decisions on your behalf is an attorney. You can have more than one attorney. You can organise a Lasting Power of Attorney ahead of time, so that it’s ready when you need it.

You can also choose a person to make decisions on your behalf about your health and welfare. This is called a Health and Welfare Lasting Power of Attorney. A health and welfare attorney can decide about your medical care, where you are cared for or what you eat.

Registering a Lasting Power of Attorney is slightly different in England, Wales, Scotland and Northern Ireland. This is explained on the relevant government websites. 

Individualised care planning

An individualised care plan is a plan of care that your healthcare team writes after they have had a discussion with:

• you
• the people important to you
• the rest of the team caring for you

The individualised care plan includes your:

• personal goals and wishes
• preferred place of care
• current needs and needs you might have in future

The plan also includes:

• how you would want your symptoms to be managed
• whether you would like to have fluids to keep you hydrated at the end of life
• any care needs after your death
• any resources needs