End of Life Planning
Sometimes cancer continues to grow aggressively despite the best medicine and care available. When you are told that cure is no longer the goal of treatment, you will experience a range of emotions. You, and your loved ones, will feel overwhelmed and will deal with this news in different ways. Acceptance will come with time. And it will allow you to focus on what is important and how best to spend the time you have left.
Based on your medical history, your doctor may give you an estimate for how long you may live. However, no one can predict this exactly. Some people live much longer than expected, and others may die sooner. It might be prudent to create your advance care plan (ACP), a record of your wishes about your future healthcare decisions. This plan will guide your substitute decision-maker or the person to whom you have given power of attorney if you are unable to make your own decisions—for example, if you fall into a coma, or your illness impairs your ability to make decisions. You will create your ACP through conversation with your healthcare team and your loved ones, and by reflecting on your own values and beliefs. Take this opportunity to discuss your preferences and fears. For example, many people with cancer have fears about living their last days in pain or feeling short of breath. An honest discussion will help alleviate these fears. You can learn more by going to www.advancecareplanning.ca. It is advisable at this time to make decisions regarding power of attorney, a will, and organ, tissue, or body donation. You may also choose to pre-plan or speak to your family about your wishes for a funeral or memorial service.
You will continue to receive palliative care to relieve symptoms and give you the best possible quality of life. You can receive this care at home, at a clinic or hospital, or in a hospice. It is important to remember (and let your loved ones know) that choosing to stay at a hospice does not mean that you do not want to spend time at home or that your family is failing to take care of you. Conversations with your family and your healthcare team can help you determine which type of care you would like and when. You may feel most comfortable at home and want to be there as long as possible; or you may want to take advantage of the extra medical support and care available for you and your loved ones at a hospice. If you are considering medical assistance in dying, a member of your healthcare team can provide more information for you and your loved ones. Information is also available at www.canada.ca/en/health-canada/services/medicalassistance-dying.html.
You and your loved ones will feel profound grief at this time—not just extreme sadness, but also anger, guilt, confusion, and denial. It is important not to ignore these feelings and not to isolate yourself. Talking to your family, a close friend, or a mental health professional will help you process the complicated and painful emotions that you have. This will take time, but by sharing your grief you can help each other heal and ease your burdens.
Preparing your children
Many parents, of all ages, avoid talking about their illness or about dying, simply out of love and a need to protect their children from harm. Children, however, do better and are more resilient when their parents explain to them the nature of the disease, and assure them that they will not be abandoned. If your cancer is no longer responding to treatment, telling your children about it will help them adjust and prepare for the future. Regular family discussions about what is happening in each of your lives can be a natural opportunity to keep your children informed. Social workers at your children’s school can also help and support your children during this difficult time. Use gentle, direct, age- and stage-appropriate language to explain the changes. With young children, you can use phrases such as mommy is getting sicker, mommy is getting very sick as things change, and later mommy is very, very sick and will not get better. These phrases convey a message of increased illness and help move the children along in their understanding of the illness.
During this time, there are many things you and your children can do together to recall, reflect on, and create new memories. The suggestions below can be an investment in your children’s futures and can make an enormous difference to their well-being and adjustment after you are gone.
- Make a photo album to capture favourite moments; or talk about these memories and write about them together in a memory book.
- Fill a memory box together with favourite things that will remind your children of your best times together. Jot down thoughts and stories on small cards.
- Write on greeting cards for future occasions and milestones where your children will think of you and miss you—birthdays, holidays, graduations, weddings, and the births of their own children. You can also leave them gifts or mementos for important events.
- Write letters or record videos telling your children your hopes for their futures, and advice they will need at different stages of their lives. Although you may not be there in body, you will be there in spirit and in their thoughts.