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Transitional Care Planning

End-of-Life Decisions

Caring for a person with cancer starts after symptoms begin and the diagnosis is made and continues until the patient is in remission, is cured, or has died. (See the PDQ summaries on Last Days of Life and Grief, Bereavement, and Coping With Loss for more information.) End-of-life decisions should be made soon after the diagnosis, before there is a need for them. These issues are not pleasant or easy to think about, but planning for them can help relieve the burden on family members to make major decisions for the patient at a time when they are likely to be emotionally upset.

A patient's views may reflect his or her philosophical, moral, religious, or spiritual background. If a person has certain feelings about end-of-life issues, these feelings should be made known so that they can be carried out. Since these are sensitive issues, they are often not discussed by patients, families, or doctors. People often feel that there will be plenty of time to talk later about the issues. Many times, though, when the end-of-life decisions are necessary, they must be made by people who do not know the patient’s wishes. A patient should talk with the doctor and other caregivers about resuscitation decisions as early as possible (for example, when being admitted to the hospital); he or she may not be able to make these decisions later. Advance directives can ensure the patient's wishes are known ahead of time. (See the Legal Assessment section for information about these forms.)

These issues are important to discuss whether a patient is being cared for at home; in a hospital, nursing home, or hospice; or elsewhere.