Advance Care Planning: Empowering Each Person Through Their Cancer Journey

Nobody wants to imagine a crisis, but most medical emergencies don’t arrive with a warning or a neat checklist. We sit down with Dr. Galicia-Castillo, a leader in geriatrics and palliative medicine, to talk about advance care planning in plain terms and why it should start far earlier than most people think. The goal is not to predict every possible outcome. The goal is to protect your voice and lighten the load on the people you love. 
 
We walk through what an advance care plan actually includes and why naming the right health care proxy matters more than trying to script every medical scenario. Dr. Galicia-Castillo shares a powerful story about how a completed plan can bring peace after an unexpected tragedy, and she explains what can happen when you do not choose a decision maker and state law takes over. We also talk about complicated family realities, including separation and blended families, where the “default” decision maker may not be the person you would want. 
 
From there, we dig into quality of life, how to clarify your values, and how those values guide real medical decisions when technology, such as ventilators, dialysis, and other life-sustaining treatments, enters the picture. We also explain the difference between advance directives (guidance) and medical orders, such as DNR and POLST forms. Finally, we cover practical next steps: where to find conversation tools, how to share copies with your surrogate decision-maker and your doctor, and how to make sure your documents are accessible while traveling. 
 
If you’ve been putting this off, use this conversation as the nudge to start. Subscribe, share this with someone you care about, and leave a review. Who would you trust to speak for you if you couldn’t? 

Resources Mentioned in this Podcast:

The Conversation Project: https://theconversationproject.org/wp-content/uploads/2020/12/ConversationStarterGuide.pdf 

US ACP Registry: https://www.usacpr.com/

Advance Care Planning Guide and Forms for VA & NC (Spanish Available): https://www.sentara.com/patientguide/advance-care-planning

Virginia Advance Directives Page: https://virginiaadvancedirectives.org/
Link to Forms (scroll down the page under the map): https://virginiaadvancedirectives.org/completing-an-advance-directive/ 

Thank you for listening! If you're interested in hearing more from Virginia Oncology Associates, make sure to subscribe to Cancer Care Connections on Apple Podcasts, Spotify, or anywhere podcasts are available, or listen online at cancercareconnections.buzzsprout.com.

Cancer Care Connections is the official podcast of Virginia Oncology Associates. For more information, visit us at VirginiaCancer.com. or find us on Facebook or Instagram at Virginia Oncology Associates.

Transcript

Host: 00:06
Welcome to Cancer Care Connections. Today, we're sitting down with Dr. Marissa Galicia-Castillo, and we're talking about something that many of us intend to do someday, but often put off until it's too late: Advanced Care Planning. In this episode, we'll break down what an advanced care plan actually includes, why choosing the right medical power of attorney is one of the most important decisions you'll make, and how your personal values can guide medical decisions if you're ever unable to speak for yourself. We'll also discuss common family situations, the differences between advance directives, DNRs, and pulsed forms, and practical steps you can take today to get started. Whether you're 18 or 80, healthy or living with a serious illness, this is a conversation everyone should have.

Cheryl: 0:57
Dr. Galicia-Castillo directs the Glennan Center for Geriatrics and Gerontology and is board-certified in Internal Medicine, Geriatrics, and Hospice and Palliative Medicine, and is a nationally recognized leader in caring for aging and seriously ill patients. Thank you so much for joining us today and sitting down and being on the podcast. 

Dr. Galicia-Castillo: 01:19
Thank you so much for the invitation. Very excited to talk about advanced care planning.

Cheryl: 01:24
Yeah, I want to start by asking why you chose this specificity in medicine.

Dr. Galicia-Castillo: 01:30
Sure. So advanced care plans, I always think of are very misunderstood. And it's really a part of palliative medicine, which is a fairly new field in medicine where you work with folks who are seriously ill. And unfortunately, a lot of people think of palliative medicine; end-of-life. And so a lot of people are very scared when they hear advanced care planning and palliative medicine, when the reality is these are things that we need to talk about way, way earlier, not at the end.

Cheryl: 01:57
I would agree. I think you have a number of people, and I think I'm gonna put myself in that group. You're in that sandwich where you're taking care of children and then you're taking care of aging parents, and you feel like you're so busy that you can't handle either one of those things. But this is most likely one of the things that I imagine you would say we need to think about sooner rather than later. 

Dr. Galicia-Castillo
Absolutely. 

Cheryl: 02:22
So let's get started. Let's talk about this. What would you say is the biggest misconception that patients have when you bring up something like an advanced directive or a living will?

Dr. Galicia-Castillo: 02:33
Kind of as I just mentioned, I think people, when they hear those terms, advanced care planning, living will, the first thing that pops up into their minds is, oh my gosh, am I that sick? Am I gonna die soon? And it really needs to be a conversation that we have with anyone who is an adult. I was just joking with the team here that when my son turned 18, we actually had an advanced care plan workshop, which was a few days after he turned 18. And I said, "This is perfect. You'll be just in time." And it was very interesting to see the looks he got as a young 18-year-old getting it done. And he took it as, well, this is normal because his other sisters who are a little bit older had theirs done, but making it really a normal part of our lives. It's part of adulting. And as soon as we turn 18, we need to take care of it.

Cheryl: 03:25
When you said 18, it made me think, wait a minute, I have a newly turned 18-year-old son. And I was going to ask you when, as an adult, you have that conversation and you answered my question. 18 is not too young to have this conversation. When do you normally find people have this conversation?

Dr. Galicia-Castillo: 03:45
Normally, it's when things are not going well. That's when people are normally having these conversations, which that's why we need to change the norm, because that is not the time to have those types of discussions. I do a talk with the high school seniors at Maury High School in this area, and it's part of their bioethics course, I believe. And it was just so fascinating to hear their take on it. Well, this sounds so important. Why are we just hearing about this now? They're seniors, so what, 17, 18 years old? And what was even more fascinating was after I was talking with the teachers, the teachers were saying, "You mean to tell me my 18-year-old might be making decisions for me?" I was like, "Yeah." So if you don't have any conversations, it could be very uncomfortable; it could be very disruptive. To have a conversation ahead of time, ahead of anything, just makes such a difference.

Cheryl: 04:40
You said it earlier, this is a conversation that people don't really want to have, and they usually have it too late. But it's also one of those conversations that if somebody hears it now, and we have people listening to the show who are patients, caregivers, loved ones, friends, anyone can benefit from having this conversation and thinking about it now, rather than later when it can be a little bit too late.

Dr. Galicia-Castillo: 05:05
Yes, absolutely. Actually, we were just talking about this earlier today. They said, " When is a good time?" We just had a journal club with our fellow. And "is it too early? Is it too late?" Well, it's always too early until it's too late, right? So just do it when you can do it. It's one of those things where nobody enjoys having some of these conversations because they're tough. But if you do it when you're well, and you have a good frame of mind, it makes such a difference when someone is in a situation where now the emotions are going, and it's hard to think. You really don't want to have to think about those things. It should have already been determined, or at least have some idea of what people feel are important, so that when or if that time comes and they're in a tough situation, you don't have to worry about that part as much.

Cheryl: 05:53
Other things are going to be pressing, and you hope that this is not that thing. Absolutely. I want to ask you if you can share a story, obviously with the names taken out or changed, but can you share a story of a time when having this advanced care plan was able to bring peace of mind to a patient navigating cancer or another illness?

Dr. Galicia-Castillo: 06:19
Sure. Something that always comes to mind is a story- It was from a few years ago. There was a medical student who was in a class. It wasn't a requirement, but they had the opportunity to complete their own advanced care plan. And so as part of that class, she did it. You didn't have to, but she did it and got it signed off. So it was a legal document. And I want to say, about a year after that, unfortunately, she was in a car accident, and her mother had no idea she had this done. Someone found a copy of it, and it just gave her so much peace to know she wasn't making a decision. What she was doing was following through with what her daughter felt was important to her. So that's always top of mind for me because the whole point of an advanced care plan is it should really be a present to your family. It's a gift because you're no longer making decisions. You are following through with whatever that person would have wanted. It sounds like it's the same, but it's very different because the weight of a decision is no longer there.

Cheryl: 07:17
I like what you said. You're just kind of following through on a plan when something awful has happened. You're just going through a checklist, right? So, what is an advanced care plan? What do we need to think about? What questions should we be asking? What do we have to put in that checklist?

Dr. Galicia-Castillo: 07:34
Sure. So an advanced care plan is really made up of two parts. The first part is selecting someone who will be your voice if you're not able; if you're unconscious or you're not able to answer questions, you're confused. So that's the first part. That's your medical power of attorney. Other terms are things like healthcare proxy, your surrogate decision maker. There's all sorts of different terminology, but it's the person that you trust will make decisions that you would make for yourself. And then the second part is the living will portion. And there...some folks have certain things they would want or not want. And so it gives folks an understanding of how much burden is someone willing to bear for whatever may be coming next. So that's what the advanced care plan is. It's those two parts. You can have one or the other, but ideally, you want to have both. And a lot of people will, whenever I ask in lectures, so which one's most important? And people will say, " Oh, the living will." I say it's the medical power of attorney because a living will never account for every single situation that may occur. But if you have the surrogate decision maker available, they can think it through because they know you as a person. And they can then figure out, well, gosh, in this situation, we didn't really have specific conversations about it. But based on what I know of that person, this is what I think the decision they would make.

Cheryl: 08:59
Okay. So finding that person, the first part of it that you mentioned, is critical because that person has quite a lot of power. And sometimes people don't make that decision until it's too late. And then the people who think that they would be that person, they're kind of in flux. So talk through what people should be thinking about as they make that critical decision about who that who is.

Dr. Galicia-Castillo: 09:24
Sure. A lot of people will say, " Oh gosh, of course it would be my spouse", or " Oh my gosh, it would be my sister or my brother or my cousin". But you have to really think about- is this person, number one, emotionally stable with things? I've heard some people say, oh, no way, my spouse is definitely not my medical power attorney because they would never...they just wouldn't know what to do. And so some people have selected their parents or maybe even their children. So it needs to be someone that you know will follow through with what you would want, not what they would want. And I've had a few people who have said, yeah, they're just gonna do whatever they can do to keep me here, and that's not necessarily what I want. So, make sure you pick that person who will follow through with your decisions. And then the other piece that I have found just fascinating is that if you pick someone, make sure they know that this is a responsibility that you have put on them. We've had circumstances where folks, I call them up because they're on the advanced care plan, and they have no idea. This needs to really be not only thought through, but talked through as well with that person.

Cheryl: 10:36
This is not the time to be secretive. Like this is not a situation, not at all. What happens if you don't have an advanced care plan?

Dr. Galicia-Castillo: 10:46
So if you don't have an advanced care plan and you haven't selected anyone, then the person who will make medical decisions for you is decided by the Commonwealth of Virginia or whatever state you're in. And so the way it works in Virginia, it's a guardian who would make decisions if you have a guardian. Then it's the spouse, unless you're in the middle of a divorce. After the spouse, it's your adult children, and it has to be majority rules. So it has to be all of them, and it's not a consensus, it's a majority. So you can only imagine if they don't agree with one another. If you don't have adult children, then it goes to parents, and it's biological parents. After parents, then it is your siblings, all adult siblings. And again, majority rules. And if it's not siblings, then it's any blood relative. So it can get pretty dicey in terms of who makes those decisions. Let's say you don't have family at all. If you don't have an advance care plan, you have to go through all these legal motions. You have to get a guardianship. I mean, it's a mess if you don't have one.

Cheryl: 11:59
So make those decisions when you have the choice. Yes. Good info. I did not know that. It did not even occur to me. I guess I thought maybe the doctor would have that, but it's not.

Dr. Galicia-Castillo: 12:11
Yeah, and that's a selling point in terms of the medical decision maker because some people are like, I don't want so-and-so to make decisions for me. It's like, oh well...especially. We've seen this where people are married, and, you know, getting divorced is expensive. Some people never get divorced. They're just separated. And so they've been separated 40 years. And of course, they had their own, you know, partners at this point. Well, guess what? Those partners had no say so. It's the spouse that you haven't seen in 40 years. Who cares about this other person you've been with for 30? It's gonna be that spouse that you have not talked to in 40 years that will be making those medical decisions.

Cheryl: 12:49
Let's talk about how you help the person who's making the decision about their advanced care plan. How do you help them think about what quality of life means to them when they are not 100% feeling well?

Dr. Galicia-Castillo: 13:03
What does quality of life mean? Yeah. So, quality of life is going to be unique for every single person, right? So if you had a room of 50 people, you'd have 50 different quality of life statements. And so, how I guide people when they complete these forms is to think about your ideal day. What does that look like to you? Some people will say, Well, I want to be able to talk with my family. I want to be able to make my own decisions. I want to be able to do for myself as much as I can. So oftentimes, I'll hear there are three buckets that things kind of fall into. So the first bucket I think of is people want to live as long as possible. The second bucket is someone wants to be as functional as possible, be able to do for themselves. And the third bucket is the quality of life, whatever that is. And so one way that we try to help people figure this out is, I would hope people would want all three, but as you go through a serious illness, you have to sometimes prioritize what is going to be the most important thing to you. And then that in itself helps the physicians, helps the providers if they need to interpret their advanced care plan. Based on what is most important, the healthcare team can then make recommendations as to, okay, maybe this is going to be the next step that would help you get to that goal. I think a lot of people get hung up on, well, I want to be put on a ventilator, maybe for three days, not more than seven, maybe I want to be on dialysis. Oh, I want that left ventricular assist device. There is so much technology in medicine that we can't think in those terms because that may not fit your particular situation. But if we understand what is most valued to you, then as the surrogate decision maker or as a patient, you're the expert in what is important to you. For the physicians, for the healthcare team, they're the experts at the medical piece. And so our goal is to come together to come up with a goal that meets not only your preferences, but also makes medical sense...if that makes any sense.

Cheryl: 15:10
Yeah, that really does. And the first thing is, as I'm hearing you, is that the patient has to be clear on what he or she wants. And then the rest of it molds to fit what that person wants. So that ties to my next question, then. We change our minds on the daily, right? How can this advanced care plan change as the person's goals or a patient's prognosis changes over time? Like, how does the advanced care plan mold to change however you're feeling about yourself and your health?

Dr. Galicia-Castillo: 15:45
So an advanced care plan is a living document. So it's going to change. Our priorities change as we age, right? So when we're single, our priorities are a certain way. You get married, or you find a partner, your priorities change then. You have children, that's a whole other game changer. If you develop a serious illness, you're going to see things from a different perspective. So it's much like a will. You need to look at it when a life change happens. You get married, you get divorced, you lose a loved one. That might be a time to go back and look at your advanced care plan. Are these still the same values that I have now, when I'm 55, as when I was 25? Probably not. So we need to look at these on a regular basis. It's funny, Thanksgiving is considered the unofficial advanced care planning time. Just to think about Thanksgiving, all the family comes together usually, and there's the time to do it. I love this one meme, and it's somebody serving the Thanksgiving turkey. And the guy's about to carve him, and he's like, I wonder if he had an advanced care plan. So it's whenever you can get everybody together and talking. It's very uncomfortable. But once you do start having the conversation, it's almost as if there's a relief. People are saying things that are in the back of their minds, and to have it said out loud just so people know what to expect when the unexpected happens.

Cheryl: 17:12
I think that, especially around loved ones, you want to do right by the people you love. I think that the idea of having it at Thanksgiving or another family gathering is good, but it can also be a little bit of a downer, I'm just gonna say. Absolutely! How do you have this conversation with a patient or a family member, even, who just doesn't want to talk about it? Like nobody wants to talk about it, even though it needs to be done. How do you make it so that this conversation happens and there's a positive result when somebody just has resistance?

Dr. Galicia-Castillo: 17:46
Sure. I think if you have someone who has so much resistance, they don't want to talk about it at all. I would recommend that you not pick that person to be your medical power of attorney. That's number one. I think that's something to keep in mind, especially if you do have a serious illness, really imparting on folks that this is their opportunity to make sure that they don't...I hate to say this, but a lot of people...they don't want to be a burden to their families. I hear that all the time. But what does that mean? I think part of it is burdening people with decisions. You'll hear people talk about being burdened from a financial standpoint, but I think it's really about making those decisions. And if they can be reframed in such a way that the person who wants to talk about advanced care planning can look out to their families and ask them, I want you to help me help you. And sometimes that helps. Some people are just going to be very resistant. And so maybe this isn't the time, but at least it's been introduced, and maybe there's another time in the near future they can continue those conversations. But again, if you're running into someone who just doesn't want to talk about it, please don't pick that person to be your medical power attorney. Because if they can't do it in your presence, imagine now you're unconscious, or you're in a situation where there's a lot of things going on, that's not going to be helpful to you or to them.

Cheryl: 19:07
No, no, that would be really difficult in a time that is already very challenging. I want to talk more about kind of the logistics, if you will. So you've mentioned some things that might be new terms, right? Living will, medical power of attorney. Let's talk about a DNR, a do not resuscitate. And can you talk about what these mean and what we, as loved ones, caregivers, patients, need to know about these terms and how they work together.

Dr. Galicia-Castillo: 19:40
Absolutely. So when we talk about advanced care planning, the living wills, medical power of attorney, those are all guidelines. They're not medical orders. So as a physician, if I get a copy of someone's advanced care plan, I could get a good idea of who this person is, what's important to them. Perhaps make some recommendations. So that's one part. When you talk about a DNR, which is a do-not-resuscitate form, that is a durable document. Those are actual medical orders. So when someone has a conversation, and they've decided they want to be allowed a natural death, which is DNR, do not attempt resuscitation. Then, if they feel very strongly about that, an advanced care plan is not going to help them. Then they need to go to their physician or their healthcare team and say, "These are my wishes. I want to be allowed an opportunity to die naturally. Don't do CPR, don't put me on a machine." Then that needs to be done with the physician, physician assistant, nurse practitioner, or provider so they can fill out what's called a durable, do not attempt resuscitation form. Now, one thing I do have to mention, every state is a little bit different. So all of these forms and documents are different from state to state. So, in Virginia, an advanced care plan still has the two parts. But in Virginia, I have to say they want to make it as easy as possible to get it done. So in Virginia, you only need two witnesses, and that's it. You don't need a notary, you don't need a doctor, you don't need a lawyer, just two witnesses who could even be related to you. It could even be the people that you've named. I generally recommend getting two different people who are different from the people that you've named. It just makes it a lot cleaner. In other states, for example, in North Carolina, which is right there, they require a notary. They also require that the witnesses are not related and are not part of the healthcare team. So just keep in mind they're different state to state. Now, the durable documents, so the durable DNR, is again state-specific, needs to be done by a healthcare provider, needs to be signed off by either the patient or the patient's designee, and the physician or the provider. Now, there is also a form in Virginia which is called the Polst Form, P O L S T. It used to stand for Physicians Orders for Life Sustaining Treatment. Now it's actually just a word, Polst. And so that is a document that is recognized, I want to say in about 40 states. Again, they're very state-specific, but that particular one, Virginia, is part of the National Polst Initiative. So that form actually looks at being allowed a natural death. It also talks a little bit about what is most important to you. Are you at a point where you want to focus only on your comfort? And that's called comfort measures. Or are you at a point where you're willing to bear the burden of a few things, but not everything? And that's selective treatment. And then the other is, I want to go full core press with everything at this point. And that's then called full treatments. So it's a little bit more detailed than a durable DNR, because it gives a little bit more details about what's important and where you are at that particular time. So that's the main difference between your advanced care plan, which is again a guideline, and then your durable forms, your polst form, durable DNR. Those are actual medical orders.

Cheryl: 23:03
And you need both, correct?

Dr. Galicia-Castillo: 23:05
You don't need both, but if you feel strongly about certain things in terms of treatment plans, being on a ventilator, dialysis, any of those things, then I would recommend you get a polst form as well.

Cheryl: 23:19
It's something that a person really needs to think about. They really need to have that sit-down with myself moment or talk to loved ones to make this decision before something happens and your wishes are not honored.

Dr. Galicia-Castillo: 23:34
And the thing is with medicine, there's been some amazing, amazing advancements in medicine. But we're still at a point where we haven't cured death, right? And so all of us are gonna face this at some point. And that's just a reality. And so we need to, when we have these conversations, think about whether we are prolonging life or prolonging death? It's a fine line. So what is important to you? So that's why it is very important to understand people's preferences because there is a certain point where which one are we doing? And it really is in the eye of the beholder.

Cheryl: 24:09
And I think as you're discussing it, it is a choice that somebody needs to make for themselves. So this conversation can be very timely in some cases. As you're hearing it, I think I feel too; sometimes these shows come into people's feeds when they need to hear them. And so this conversation may be so timely for the right person at the right time. 

Cheryl: 24:31
So, Doctor, let's just say a person is hearing this and says, " Okay, I want to do this. I'm ready. I haven't had the conversation with a loved one yet. I haven't really thought about it. What do I do first? Where do I get the forms? Do I file them somewhere? What are the steps that I take right now?"

Dr. Galicia-Castillo: 24:50
So if someone's looking for information, first, I would recommend, there's a great website out of UCSF called the Conversation Project. And it has a conversation starter workbook where you can work through these questions by yourself. And it helps get you in the right state of mind. So v some great resources online. Now let's say you're ready to complete an advanced care plan. If they're at VOA, then they talk to their team and say, I'd like to get an advanced care plan done. They will get one of the medical oncology social workers to help them complete the form. Let's say you get it done. That's awesome. You got a copy. Now you put it in your safety deposit box, and nobody can get to it. That's not really helpful. So you can actually upload your advanced care plan to this U.S. advanced care plan registry, so that if you have one, they send you a sticker that you can put on your driver's license to say, " Yes, I have a US advanced care plan." And there's a phone number. So they can pull it up no matter where you are. Let's say you're traveling to Florida or California or wherever, and they need to get a copy, they can pull it up. So you want it to be available to everyone. When you get your advanced care plan done, then copies need to be made. You should have a copy. Your medical power of attorney, your surrogate decision makers, they should have a copy. Your physician should have a copy. Anytime you go to a hospital, they have to ask, do you have an advanced care plan? Here you go. There's your copy. So then that way it's in the electronic medical record, no matter where you are.

Cheryl: 26:26
As I hear you talk, I imagine that the people around you have one of these. The people probably in your immediate circle, they probably uh hear you talk about this. And you're looking around too. I'm looking around like they probably do. I'd love for you to talk to us about how much better a person feels once they have these decisions made.

Dr. Galicia-Castillo: 26:47
As you mentioned, that initial push to just even start the conversation, I think, is the hardest part. That's with any project that you want to do. It's those first initial steps. But once it's done, it's been said out loud. And now people know, okay, that's what they would have wanted. And actually, I think there are these death cafes. It's not the best terminology, but essentially, people come together and talk about the end of life. They talk about what their preferences are. Again, I don't really love the name, but I love the concept where people can come together, and they're not even people who may know each other. Sometimes it is easier to talk about these things with people who are complete strangers. But what's so interesting is that people have thought about it, and they're like, " Oh, wow, you've thought about that too? Well, what do you think about this or that?" So once you have initiated it, it's not as tough or bad as you think it is. But I can tell you from the physician side, the families where they've had conversations before they even step foot in the hospital, those are the conversations that I guess go the best, if that makes any sense, because there's not the drama. There's not the conflict. Well, Mama said she wanted this. Well, then the sister on this side is like, " What are you talking about? That's not what she told me", or the cousin from California coming in. There's not that drama. And that makes such a big difference, especially in the already difficult situation.

Cheryl: 28:10
Everyone's distraught already. No one feels good, but not having that one extra piece of anxiety. I can imagine in any of those rooms, that is something that can be done away with, which could be nice. What other things would you care to say about someone who's listening to this? Somebody who maybe doesn't want to think about this, but now is, because of our conversation, any last things you'd like to share with them about how important this is, how beneficial it is?

Dr. Galicia-Castillo: 28:40
I think the biggest piece is that this needs to be a normal part of our conversations. I think that's where the rub is. Everybody hears about it, and they get nervous, but it should be a normal part of what we talk about. It's kind of along the same lines as having a will. Everybody should have a will, but does everybody? No, because they really don't want to talk about it. I'll just say if you don't have a will, then you have to go through probate and all of that craziness, and it takes years. And it's similar to that. If you can just have that discussion earlier on, and you want to talk about it when you're well. That's the time to do it, not when you're sick. And so making it again, a normal part of what you do. And anytime there's a change in your life situation, then you go back, and you readdress your advanced care plan. Again, a living document. It should be something that we are doing on a regular basis. I think that's the part that makes it tough. It's not normal yet. And we need to. You're working on it, right? We're working on it. We're working on it.

Cheryl: 29:40
My takeaways from our conversation is 18 years old is not too young and Thanksgiving. They'll be here before we know it. It will be. And every year after that is when you can revisit that conversation. Dr. Castillo, thank you so much for your time and your expertise, and this conversation starter that you can and should have the next time you're with your loved ones.

Dr. Galicia-Castillo: 30:09
Thank you. Thanks for the opportunity for me to talk about it, because I think the more we talk about it, the easier it becomes.

Host: 30:20
Thank you for joining us today on Cancer Care Connections for this important conversation about advanced care planning. As Dr. Galicia Castillo shared, advanced care planning isn't really about paperwork. It's about communication, preparation, and making sure the people who care about you understand what matters most to you. Taking the time to choose a trusted decision maker, discuss your wishes, and put a plan in place can provide clarity and peace of mind for both you and your loved ones. If today's episode inspired you to start the conversation, don't wait for the perfect time. Talk with your family, speak with your doctor, and explore the resources available to help guide the process. And before you go, consider this question: Who would you trust to speak for you if you couldn't speak for yourself? Make sure to check out the show notes for all resources mentioned in this episode. 

Don't forget to subscribe to our podcast via Apple Podcasts, Spotify, or anywhere podcasts are available, or listen online at CancerCareConnections.buzzsprout.com. Cancer Care Connections is the official podcast of Virginia Oncology Associates. For more information, visit us at VirginiaCancer.com or find us on Facebook or Instagram at Virginia Oncology Associates.