Charting Your Course : Teach Charting Your Course : Seminar III - Facilitator's Guide

Participant Material for Seminar III
Evaluation Form for Seminar III

Materials

Objectives

Opening

Is there anything from the last session that people wish to discuss?
List the objectives of this session

Spiritual Issues

Most of us who are faced with a serious illness find ourselves giving some thought to the issues of purpose and meaning of life as well as to the fact of our mortality. We'll call these thoughts "spiritual issues", recognizing that there are many other ways to refer to these questions of soul or spirit or essential nature or higher power or God.

For many, our experience of spiritual issues will have a lot to do with how we live with illness.

It is important to ask the question: What gives my life meaning?
This can take many forms: religious faith, family & friends, good works, belief in the goodness of all, nature, etc. Looking for meaning can be an important and rewarding pursuit and shape your experience of living fully.
Exercise:
Distribute index cards to participants: have everyone list a few things that give life meaning.
Share the lists.
Discussion points:
What did you learn about yourself?
What surprised you?
Is there any next step that you like to take now in relation to your spiritual experience?

Worries

All of us, some more than others, go through this life with a changing set of worries on our minds. When faced with a serious illness, or when a loved one is suffering the pain and distress of disease, these worries are often muliplied. If we are not careful, our worries can get in the way of clear thinking and of our relationships to one another.

Keeping worries to ourselves is not the best way to deal with them. Worry can have a physical impact on the body, draining vitality if we do not find healthy ways to deal with them.

Some people find it helpful to keep track of their concerns in a journal, expressing them on paper. Putting things on paper is one way to get them "out". Others talk a little or a lot about what is worrying them, finding relief in sharing their concerns with friends who will take the time to listen and understand. Some express their worries in bouts of crying, which relieves the emotion but does not resolve the issues. Some express their concerns in a general anger or irritability that can be difficult for friends and family.
Exercise:
This is an activity to help people recognize the worries that may be draining their energy.
On a sheet of paper, list what worries you as you think ahead. Try completing the sentence "I am worried that...."
List what worries you have about the other (worries about the patient if you are a caregiver; about caregivers if you are a patient).
To whom could you turn for help and support?
Think of questions you might ask your physician or others who could give you information that would ease those concerns.
What could you or the people in your support network do to address the issues?
Share the lists
Discuss differences, surprises, what you have learned.

Decision-Making & Planning

Advance Directive forms, a Living Will and a Durable Power of Attorney for Health Care, give you an opportunity to verify your own wishes about medical care and to make those wishes known to your physician, your family, and others who care about you.

Years ago, we did not have the choices in medical care that we have today. Seriously ill people, young and old, were more likely to die quickly of natural causes than they are today. Now, medical technology can extend the life of seriously ill people for longer periods of time. It can even keep permanently unconscious people alive for many years. This has created choices that just a few years ago would not have seemd possible.
Sometimes, the new technology seems truly miraculous in its ability to restore health to someone who is seriously ill. At other times, it only seems to prolong suffering and the dying process.
- From "Taking Steps to Plan for Critical Health Care Decisions", Advance Directive forms, State of Vermont
Thinking about these issues now, and sharing your thoughts with your physician as well as with your family, gives you and your loved ones the opportunity to prepare. Your interest might be a catalyst for others in your family to complete the same forms; we should all have Advance Directives on file in case of a medical crisis that could happen to anyone at any time.
The Durable Power of Attorney for Health Care is a legal document that allows you to appoint someone to make a broad range of health care decisions for you if, for any reason, you become unable to make those decisions yourself. the Durable Power of Attorney for Health Care can cover any health care situation in which you are incapable of making your own decisions. You can use the Durable Power of Attorney for Health Care to instruct your agent to request all available care or to limit the types of care you will receive.
The Living Will, also called a Terminal Care Document, is a legal document that can direct your doctor not to use "extraordinary measures" to prolong your life if you are incurably ill and expected to die soon. It allows you to express a desire for comfort measures only at that time. That is how the Living Will is generally used, however you can also use it to indicate that you want to receive all available treatment within generally accepted medical practice.

We urge you to complete Advance Directive forms for the state in which you live. Discuss any questions you may have with those who can help: your physician, your lawyer, clergy, or other advisor. We should all leave copies of our Advance Directives on file with our physician, and also with our lawyer, if we have one.
Even more important, give a copy to each family member and discuss it with them. It is sometimes helpful to assemble the family at one time so that everyone who might be involved in carrying out your wishes has an opportunity to hear directly from you about your concerns and your hopes. If family members understand what it is you want, it might ease the confusion and misunderstandings that could occur under pressure at a later time.

Distribute Advance Directive forms.
Discussion points:
What is hard to think about?
What are the areas in which you need more information?
Which of your family members will find it comfortable to discuss such issues?
Which family members will have a hard time?
What questions do you have for your physician?
Have you ever discussed these things with your physician? Will he or she be willing to talk with you about them?
What do you want to discuss with your family/friends?

Homework Assignment

Complete an advance directive if you do not have one already.
If you have already completed an advance directive, then review it and see if you want to change anything.
Talk with your family about your health care wishes.

Communication with Physicians

Refer to seminar material on communicating with physicians
Discussion points:
Ask for what you want
Prepare and ask questions
Record your experience
Acknowledge memory loss if it is an issue
Bring companion to take notes at meetings with your physician
What advice would you give a new patient and family about communication with their physician?

Closing

Discuss with the group: what might be an opportunity for you in your experience of cancer?
Are there any comments or questions on today's session?

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This content is derived from the "Charting Your Course Seminars: A Whole Person Approach To Living With Cancer", provided by Norris Cotton Cancer Center.
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