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Advance Care Planning

Advance Care Planning (ACP) involves thinking about and writing down your wishes and instructions for your health. It includes choosing the people you want to make decisions for you, if you cannot speak for yourself.
What is Advance Care Planning (ACP)?

Advance Care Planning (ACP) is the process of planning for future health care. You think about what matters to you - your values, goals and health care wishes, and share these with the people important to you and your health care team.

ACP includes choosing the people you want to make decisions for you, if you cannot speak for yourself.

Why should I have an advance care plan?

You might have done some other types of life planning already, such as writing a will, saving for retirement or appointing a guardian for your child. 

ACP is another type of life planning. It's planning ahead for your future health and personal care.

ACP is another type of life planning, like writing a will, saving for retirement or appointing a guardian for your child.

When should I make an advance care plan?

You can make an advance care plan at any time. However, the best time to make an advance care plan is when you are healthy and make your own decisions. 

At BC Cancer, we talk about advance care planning with all of our patients to make sure we are giving each patient the best possible care.

Tools to help you plan

We have some tools to help you with the advance care planning process. 

Click the boxes below to learn more, or ask your health care team for paper copies on your next visit.

 
Four reasons to talk about ACP with your health care team:
  1. ACP improves your experience of care by focusing on what matters most to you.
  2. ACP helps you make informed decisions about your health.
  3. ACP helps your loved ones during an emergency or unexpected event, by making sure your wishes are known.
  4. ACP supports you in getting the care that's right for you, even if you're unable to speak for yourself.
Think about what is important to you:
  • What kind of events and activities make you happy?
  • What spiritual, cultural or religious beliefs are important to you?
  • What does a good day look like for you?
  • What are your worries / fears / concerns and hopes for future health care?

Advance care planning includes choosing the people you want to make decisions for you, if you cannot speak for yourself.


Share what's important to you with your family, other support people and health care team.


Advance Care Planning handout

The Advance Care Planning handout outlines which things to consider for advance care planning so you can be better informed:

Advance Care Planning checklist
Preparing a basket with what matters to you
BC Cancer Library: Advance Care Planning Pathfinder

 

Starting to think and talk about your cancer journey - and what is important to you - is the first step in advance care planning. We have some tools to help you get started:

Think about your wishes for care‎
  • What is most important to you?
  • How would you like your physical, emotional and spiritual needs met?
  • If you got really sick, what would matter the most to you?
  • Think about your goals, preferences and wishes for care.
Start the conversation

It can be hard to talk about advance care planning. Use these ACP conversation starters to help you organize and write down your wishes that you can keep and refer back to:

Talk to your health care team

Once you have thought about how you would like to live your life, you will be better able to talk about your wishes for care with your health team. Talk to your health care team about:

  • What is my cancer treatment journey?
  • What are the treatment options for my cancer?
  • How will the treatments affect my life?
  • What should I be doing to plan ahead? (treatment and other life events)
  • Are there specific medical treatments I may or may not want?
  • How do my religious, cultural or personal beliefs affect my decisions?
  • How will the cancer teams work together with other teams involved in my health care?

After you have thought about your wishes for care and talked to your health care team, you may be ready to make an advance care plan. Keep reviewing your plan during your journey.

 
Think about who could make decisions for you

As long as you can understand your care options and can speak your wishes (you are capable), you will be asked to make decisions and give informed consent for your health care treatments. 


Sometimes during cancer treatments, people get very sick for a short time and are not mentally or verbally capable. Examples are bad infections (sepsis), or reactions to the cancer treatments.


Substitute Decision Maker

If you are not capable, you will need a Substitute Decision Maker. You should decide in advance who you would want to be your Substitute Decision Maker. This person will make health and personal care decisions for you, based on what is important to you.


It's important to talk with your family and Substitute Decision Maker about what matters most to you. This helps them feel more prepared if they ever need to make decisions on your behalf.


There are two ways to have a substitute:

1 - You legally name a Substitute Decision Maker 

  • Use the Enhanced (section 9) Representation Agreement to name your Substitute Decision Maker. This is a legal form. You do not need a notary or lawyer to fill out this form. You can do this yourself.
  • A Substitute Decision Maker must be at least 19 years old and has agreed to be your decision maker.
  • If you are choosing a Substitute Decision Maker, talk to this person. Make sure they know your wishes and goals for care.  Make sure they understand their role in your care.

2 - Choose a Temporary Substitute Decision Maker

  • The list of Temporary Substitute Decision Makers is defined by B.C. law:
    • Your spouse
    • One of your children (equally ranked)
    • A parent (equally ranked)
    • A grandparent (equally ranked)
    • A grandchild (equally ranked)
    • Anyone else related to you by birth or adoption
    • A close friend
    • A peron immediately related to you by marriage
    • If no one else qualifies: A Public Guardian and Trustee
  • If you are satisfied with who would be your Temporary Substitute Decision Maker, for example your spouse, you can choose that as your option. 
  • Use the My Temporary Substitute Decision Maker (TSDM) List to show who you would want to speak on your behalf if you are unable. If the order on this list matches your wishes, you don't need an Enhanced Representation Agreement.
  • If you are not sure about who would be your Temporary Substitute Decision Maker, or if there may be conflict within your support people, it may be best to do an Enhanced Representation Agreement. 
  • If you have not identified a Substitute Decision Maker, your health care provider will work down this list to identify the first available person who qualifies and is willing to act as your Temporary Substitute Decision Maker. You cannot change the order of this list.
Some people like to have a family meeting to share their wishes with their larger family and support people, so everyone knows your wishes for future health and personal care.

As your life or your health changes, you will want to update your advance care plan. You can change your plan as many times as you want and whenever you want. Be sure to write down the changes to your plan. Tell your health care team and those you trust.

Guide for Substitute Decision Makers 

 
Working on my ACP
  • When you record your wishes and instructions for future health care, you are making an advance care plan. It is a good idea to write down your plan or record it in a video.
  • You can use the B.C. government's My Voice: Expressing My Wishes for Future Health Care Treatment to record your ACP, available in English, Punjabi, Simplified Chinese, Farsi, French, German, Hindi, Korean, Spanish, Tagalog and Vietnamese. You can also ask your nurse for a copy on your next visit. 
  • For help deciding what kind of legal document you want, use the My Voice Quick Planning document.
Examples of informal advance care plans
Tools to help you plan
Advance care planning should be reviewed as your health changes. You can change the plan as many times as you want and whenever you want. Be sure to write down the changes to your plan. Tell your health care team and those you trust about the changes.

Ask for help if you need it

Advance care planning can be difficult and confusing. You may want someone to help you make decisions and help write your plan. Talk to your health care team if you need support.
SOURCE: Advance Care Planning ( )
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