Planning for the end of life can be both rewarding and difficult.
Thinking about and planning for the end-of-life can be a difficult time for patients and their families. Each person will have unique needs and will cope in different ways. This time is easier when patients, families, and health care providers talk openly about end-of-life plans. For many patients and their families, this can be a time of personal growth. These events often give people the chance to find out more about themselves and appreciate what is most important to them.
Many of the improvements in survival in childhood cancer have been made as a result of clinical trials that have attempted to improve on the best available, accepted therapy. Clinical trials in pediatrics are designed to compare new therapy with therapy that is currently accepted as standard. This comparison may be done in a randomized study of two treatment arms or by evaluating a single new treatment and comparing the results with those that were previously obtained with existing therapy.
This summary discusses care during the last days and last hours of life, including treatment of common symptoms and ethical questions that may come up. It may help patients and their families prepare for the kinds of decisions that may be needed during this time.
This summary is about end-of-life in adults with cancer and where noted, children with cancer.
Making end-of-life plans can lower the stress on both the patient and the family.
When treatment choices and plans are discussed before the last days of life, it can lower the stress on both the patient and the family. Knowing the patient's wishes can help make it easier for family members to make major decisions for the patient during a very emotional time. It is most helpful if end-of life planning and decision-making begin soon after diagnosis and continue during the course of the disease. Having these decisions in writing can make the patient's wishes clear to both the family and the health care team. When it is a child who is terminally ill, having these discussions with the child's doctor may reduce the time the child spends in the hospital and help the parents feel more prepared for the child's end of life.
End-of-life planning usually includes making choices about the following:
The goals of care (for example, whether to use certain medicines during the last days of life).
Where the patient wants to spend his or her final days.
Which treatments for end-of-life care the patient wishes to receive.