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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 at .

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

at advancedcancer.pdf h

as a detailed worksheet

you can use.


Think about making the arrangements for a

funeral or memorial service in advance.