End-of-life Conversations with Your Children

Parents, above all else, want to love and protect their children. We expect to live to raise them to adulthood, and cancer sometimes shatters this hope. If cancer recurs and progresses, at some point, treatments stop being helpful and may even cause more harm than benefit. If this happens, it is time to talk with your children about the realities and begin to prepare them for life without you.

I have written before about discussing cancer with your children; this is hard enough. If you are fortunate and stay well, there are a few basic guidelines that can help. These include giving your children honest, age-appropriate information, trying not to change their routines too much, and promising to tell them if the time comes to worry. As long as you can say: This is not the time, family life generally goes on reasonably normally and smoothly.

Today, I am writing about how to talk when the time has come to worry. There are no easy ways to discuss your death with your children, but here are some considerations to help you begin to think about this painful process.

• Choose an appropriate time to talk, when no one is overtired and there is adequate time and privacy. Remember that this is the first of many conversations, not the only one.
• Consider whether it is better to talk together as a family or separately with each child. This depends on your particular family and circumstances, and there is no one right choice.
• Begin with a simple statement like: We need to talk about my cancer.
• As is the case with earlier stage disease, it is extremely important to give children honest and age-appropriate information.
• Young children need simplicity. You can't give them specific timing, but you can make clear that the cancer is getting worse, that the doctors are doing their very best, and that you will be facing the end of life.
• College-age and young adult children need more information about your prognosis and what they might anticipate. Together, you may decide that they should continue with school or work in a distant city, or that they should take a leave and come home. Again, there is no single right answer, only what is best for your family.
• Children of all ages need to be reminded that others will always be there to love and protect and care for them. Single parents and others who don't have an obvious partner in parenting should be prepared to explain who will be taking care of the child.
• Answer their questions, even the hardest ones, as honestly as you can. It is pretty common for a young child to ask what happens after death. If you have a religious belief, this is the time to share it. If you don't, say something like: No one knows for sure, but I am sure that it will be OK.
• Don't be shocked if a child of any age reacts with anger. Remember that the anger is not directed at you, but at the situation and the genuine terror of losing you. Be sure to tell your child that you know she is not angry with you; the goal here is to alleviate any future feelings of guilt.
• A wise colleague and psychiatrist who worked with very ill cancer patients and their families always taught that, before we die, we ideally have the chance to say three things to our loved ones: I forgive you for the times you hurt or angered me. Please forgive me for the times I let you know. Remember that I have always and will always love you.

If you would like to talk further about your children and these concerns, consider speaking with an oncology social worker.