My hopes

As we approach end of life, deciding what is important can be comforting to both ourselves and those close to us. A ‘good death’ can come from prioritising your time and energy for the things that matter most. Ask yourself: -

• What are my hopes and goals for the time I have left? 
• What brings me most happiness? How do I want to spend my time? 
• Where do I want to spend my time?
• Who are the people I want to spend precious time with? 

The answers to the questions will be different for us all depending on who we are, what we believe and value.

What matters to me can also include what is important to me after I have died, for example, having peace of mind because plans are in place, or having our wishes respected.

“What I really wanted was to get away again in our motor home, I decided I didn’t want another round of chemo – I knew that was the right decision once I had made it”. Margaret, with advanced cancer

You may find some of your hopes below: 

Being well enough to spend quality time with family and friends, going on holiday, to a family celebration, or being alive for as long as possible may be things you prioritise

For some people, thinking about what’s most important can be hard. The What Matters Most cards produced by Palliative Care, Australia can help you organise your thoughts.

"It’s well and truly advanced so I am under no illusion. We've got nothing else to lose. If some chemo can get me a bit more quality of life, that is where I am sitting at the moment”
Jason, 40 yrs with advanced cancer

When it is no longer possible to cure someone’s cancer, quality of life becomes the main focus of care.

Some people may want to continue with treatment that may keep them alive longer. Others may prefer to continue with care that allows them to spend as much time at home as possible with better quality of life.

You may prefer to feel as well as possible rather than experience likely side effects from cancer treatments.

As end of life nears, many patients will be cared for by a palliative care team, if they haven’t been already. Palliative care doctors and nurses are experts in managing symptoms at any time during a person’s illness, but especially as end of life nears. The palliative care team are important members of your cancer care team and you can ask your doctor or nurse to speak with them at any time.

 A fact sheet in 21 different languages about how palliative care can help is available on the Palliative Care Vic website.

If you haven’t been referred to a palliative care team, and you would like this opportunity, ask your nurse or doctor to contact the team on your behalf.

You might also want to ask your doctor or nurse about:

• An Advance Care Plan (ACP) can be made at anytime. This allows you to write down your values and preferences for treatment. It is can also be useful to have these discussions with important people in your life such as family or close friends
• Nominating a Medical Treatment Decision Maker (MTDM) is  important because they can make decisions about treatments on your behalf if you are not able to because you are unwell. The MTDM is someone you formally appoint or a person close to you, such as your partner/spouse, adult children, your parent(s) or adult siblings.

“Some patients knew they were not curable, but they had not discussed end of life. We empowered them to talk to their team and reassured them that it’s okay to not have treatment.”
Lisa, cancer nurse researcher

Voluntary Assisted Dying is commonly referred to as VAD. 

The Voluntary Assisted Dying Act 2017 allows people in the late stages of advanced disease to choose to take medication prescribed by a doctor to bring about their death.

For detailed information about Voluntary Assisted Dying we recommend that you refer to the Voluntary Assisted Dying on the Peter Mac website and Victorian Department of Health website.

The words of the Conversation Project are wise indeed: "It always seems to soon until it's too late"

People have told us that the hardest part of having a conversation about end of life is getting started. Having a family member or a close friend with you as you have this conversation with your doctor or nurse can be a great support.

Your doctor or nurse will appreciate the courage it takes to have this conversation and will support you to talk about what matters to you. Some staff may feel unsure about having this conversation, but they will always be happy to refer you on to a more experienced colleague:

Remember, having conversations about end of life can be emotionally draining regardless of whether you are talking to family or your cancer team.

Some health professionals suggest having conversations about End of Life when you are feeling well and have enough energy. Getting things organised for your death, and for others after you have died, can take some time, so this is a good reason to have conversations with family and the cancer team early.

Sadly, many relatives and friends of people who have died tell us that end of life conversations happened too late for their loved ones. This meant that the wishes of the patient, for example, to die at home or to have time with grandchildren, were not able to be fulfilled.

This resource has been developed to help people start conversations as early as possible, so that their wishes can be shared with family, friends and their cancer team.

People have been shown to have a greater quality of life in their last months if they have spoken with their cancer team and their loved ones about their concerns and their wishes.