NCCN Guidelines for Patients
Adolescents and Young Adults with Cancer, Version 1.2017
Thinking about the unthinkable
What is advance care planning?
Doctors are required to follow the care instructions
in an advance directive when you are too ill to give
instructions about your care.
The advance directive will include information
on how much you want your doctors to do if
your heart or lungs stop working or if you are
no longer able to eat.
Many advance directives include DNAR
esuscitation) or DNI (
ntubate) orders, which do not allow
medical providers to revive you with CPR
esuscitation) or hook you
up to a breathing machine.
It will be important to keep your advance
directive on hand because without these
papers, health care providers are legally
required to do everything possible to keep
your heart beating and lungs breathing.
Make sure everyone on your team—and in your
family—knows about your advance directive and its
This doesn’t mean that you have to choose not to
attempt resuscitation. The advance directive should
reflect your wishes—not what you think your parents
or partner would want. And keep in mind that the
advance directive isn’t written in stone. If your
thoughts on feeding tubes or respirators change, you
can always make changes.
Your advance directive should also identify a person
who is authorized to make decisions on your behalf
(health care proxy) it you can’t communicate. This
person may one day have to make some very
tough decisions, so you should think carefully when
selecting your proxy.
Researchers from the National Institutes of
Health developed the Voice My Choices: A
Planning Guide for Adolescents & Young Adults atwww.agingwithdignity.org/voicing-my-choices.php .
This is a simple but complete template for laying
out your end-of-life wishes. You can find forms for
selecting your health care proxy and your instructions
regarding life support and resuscitation.
In addition to making plans about your care,
organizing your personal and financial affairs can
lessen the burden on family and friends when you are
gone. This leaves you free to focus on other things in
the time you have left.
Clear up any insurance questions. Find
out which end-of-life services your provider
will cover and clarify any limitations in the
coverage (such as a cap on the number of
visits by a nurse or health aide).
Organize your financial records like bank
accounts, insurance policies, and mortgage
to make sure your family knows where
everything is. The National Cancer Institute’s
Coping with Advanced Cancer
atwww.cancer.gov/cancertopics/coping/ advancedcancer.pdf h
as a detailed worksheet
you can use.
Think about making the arrangements for a
funeral or memorial service in advance.