Daniel Flora, Medical Oncologist and Medical Director of Oncology Research at St. Elizabeth Healthcare, shared a post on Substack:
“Today, I spent time rounding in the hospital on a number of patients. Some had a new cancer diagnosis. Others were older or facing serious medical illness. I was struck by how often patients and families had never really talked about what they would want if things suddenly got worse.
I mean the bigger questions…like who would speak for you if you could no longer speak for yourself? Would you want everything possible done, or are there situations where comfort, dignity, independence, or just being at home would be more important? Have you filled out anything like advance directives or a living will? Does your family actually know what you would want if things suddenly got worse?
These conversations are uncomfortable, and I get why families avoid them. They can feel scary and morbid, almost like saying the words out loud might somehow make it happen. But in the hospital, I see what it looks like when these conversations never happen.
I see families trying to make really hard decisions in the middle of a crisis, often without a clear sense of what their loved one would have wanted. I see doctors and nurses trying their best to help guide families through complicated choices, made even harder because the person at the center of it all never really got to say what they wanted.
I cannot stress this enough: having these conversations early is an act of love. It protects your family. It makes sure you still have a say if the day comes when you cannot make decisions on your own.
A goals-of-care plan should start early, sometimes even before getting into all the details about cancer treatment options. Before we talk about chemotherapy, radiation, surgery, immunotherapy, clinical trials, or watching and waiting, it helps to understand the person in front of us. What are they hoping for? What are they worried about? What tradeoffs feel okay to them? Who do they trust to help make decisions? What would they want if they became much sicker?
I would rather have these conversations early, when there is still time to think things through, rather than wait until a crisis when everyone is trying to guess what the patient would have wanted.
(Here’s another photo, as my followers seem to like these! This was Spring Break, camping at Lake Powell 2025).”
More posts featuring Daniel Flora.