Despite a doctor’s best efforts and hard work, treatment sometimes stops working, and a cure or long-term remission is no longer possible.

Grieving your losses

Learning that you are terminally ill frequently brings about intense feelings of anger, fear, grief, regret, and other strong emotions. It is normal to grieve and mourn the loss of your abilities, the loved ones you will leave behind, and the days you will not have. Talking about your feelings and concerns with family, friends, and caregivers help bring you comfort.

Arranging your affairs

Although discussing death and dying is difficult and sad, it is recommended that a terminally ill person revise and review his or her wishes at the end of life with family and health care professionals. You also may revise your goals and plans as your circumstances or preferences change. Starting the conversation early strengthens your relationship with the health care team. For many people, worrying about what will happen to their surviving family members is difficult. Planning ahead to settle legal, financial, and business affairs also allows you and your family to concentrate on the emotional aspects of your illness and its effect on your family.

Settling your affairs may include locating and organizing important legal and financial documents, such as your will, marriage and birth certificates, social security card, insurance policies, bank statements, and investment summaries. If you have complicated finances or are concerned about leaving your family with high medical bills or debts, consider talking with a financial advisor or social worker. Financial professionals cannot eliminate bills or debts, but they will help you sort out your finances and lessen the stress of financial worries for you and your family. Some people also find it helpful to plan some aspects of their own funeral or memorial service. This is done with a set of written instructions or by talking with your family or close friends about your wishes.

An important step for many is to create, or perhaps make changes to, an advance directive. An advance directive is a legally binding set of instructions that explains the kind of medical treatment you want and do not want if you become unable to make those decisions for yourself. An advance directive provides a way for you to communicate your wishes to your family, friends, and health care professionals ahead of time to avoid confusion later on. People who have advance directives know that their wishes will be respected. Although an advance directive may be oral (spoken) in most states, an advance directive is less likely to be challenged if it is in writing. It is a good idea to discuss your advanced directive with your family to clarify your decisions and the values underlying them.

Completing unfinished business

As you approach the end of your life, there may be certain things you wish to accomplish in the time you have left. These tasks help bring a sense of meaning and completion to your life and may range from fulfilling a lifelong dream to more simple experiences, such as re-reading a favourite book or spending time with those who are important to you. Finding peace in important relationships and saying the things that matter most are also significant aspects of life completion. There may be conflicts you wish to resolve or apologies you want to make. You may want to say goodbye to special people and tell family members how much you love them. If you are able, you may want to accomplish these tasks in person, or you may want to pass on a message in writing, by telephone, or through a family member. It may be possible for you to travel to visit special people or for them to travel to you. Keep in mind that, despite your best efforts, people may not respond the way you want them to. Some people may not feel comfortable visiting you or may be afraid they will say the wrong thing. You may be comforted by knowing that you have done your best to heal a troubled relationship.

Reviewing your life

It is only natural to want to leave a legacy (evidence that your life mattered and that you made a difference in the world). Take time to reflect on and celebrate the events in your life; the things you have accomplished; the people you have loved, and the individuals and events that have shaped you. Talk with your family and friends about the times you have spent together and the memories and events you have shared. You will not only be honouring memories of the life you shared together but also creating new memories for them to cherish.

As you review your life, you may want to write down your memories, record them on tape or video, or ask someone to write for you as you talk. Talking about or recording your wishes and dreams for loved ones helps ease regrets about having to leave them and helps them feel connected to you at important times throughout their lives. For young children, it may be enormously helpful to leave videos and albums that remind them of your love and connection. Creating opportunities to celebrate your life will also offer an opportunity to record happy moments that your family and friends will cherish after you are gone.

Religion and spirituality

Many terminally ill patients report that religion and spirituality are an important part of their lives. For some, organized religion is a central part of life, and the support of faith and clergy members is an important source of comfort at the end of life. For others, spiritual comfort may lie in a sense of connection to nature or people. What matters is finding such comfort, completion, and peace, which will sustain hope and meaning. Studies show that patients who feel spiritually supported have a better quality of life. Patients and their families should feel comfortable asking for spiritual support and for help in finding these resources from members of the cancer care team.