Table 1.

How to introduce sections of Voicing My CHOiCES^™

Document Section	Sample Statements to Start Conversations
Introduction	“Although we are hoping that this next treatment [medicine] will be helpful, many people your age have told us that they found it helpful to have a say about what they would want or not want if treatment doesn’t go as expected. In fact, people your age helped create a guide so that they could put down on paper things that are important to.”
How I would like to be supported so I don’t feel alone	“Some AYAs say they can feel alone, even when they are in a room with a lot of people. Have you ever felt this way?”
	”When you are not feeling well, and need some support, who do you like to have with you?”
	”When you are asleep, is there someone you prefer to have near you?”
How I want to be comforted	“When you don’t feel well, what tends to bring you the most comfort? Do you like the room dark? Do you tend to want to listen to music?”
	”When you don’t feel well are there certain clothes that are most comforting to you?”
	”This is a page where you can share what YOU find most comforting so that others can know without you having to tell them.”
Who I want to make my medical care decisions if I cannot make them on my own	“How does decision making for your medical needs happen now? Are you comfortable with the way decisions are currently made?”
	”Has it ever been hard to voice your opinion?”
	”Has it ever happened to you where you couldn’t make a decision and someone made it for you?”
	”Have you ever given thought to who you would trust most to make decisions for you, if you ever become unable to make them yourself?”
	”Do you know who your mom or dad has chosen to make decisions for them?”
	”Here you can put down who you would be most comfortable making medical decisions if you were not able to. Feel free to put more than one person or to ask for the people you choose to work together.”
The types of life-support treatments I want, or do not want	“Many AYAs have told us that there was a specific test(s) that they really dislike—or find especially annoying, and if they could avoid these, they would. Have you had a specific test or experience you hope to never have to experience again?”
	”Others have thought a lot about whether or not they would ever want to have aggressive interventions, like being on a breathing machine, if their condition was not reversible. Have you ever thought about something like this?”
	”While your care team will always provide every medicine possible to help you and do everything they can to support you, here you can share any thoughts that you might have about how much mechanical support [support by machines] you might like provided if, for example, your body was not able to work on its own.”
What I would like my friends and family to know about me	“Many people your age have told us that they tend to worry more about other family members sometimes than they worry about what is happening to themselves. Has this ever been the case for you?”
	”Is there anyone in your family who is having a really hard time? What worries you most about that person? How does your family act when there is a crisis with your health or with someone else in the family? What would make you feel better knowing would happen if you were no longer here?”
	”What about your friends? Is there anyone you worry about most? Many people your age also tell us that there are certain things that they have just not known how to say to people who are important to them. Like something a friend might have done that was especially cool or meaningful. Here is a chance to tell them something that was appreciated or to apologize for something that you wish you hadn’t said. Or to maybe give forgiveness to someone who hurt you badly. It also allows you to share things that are awfully hard to express in person.”
Spiritual thoughts and wishes	“Some AYAs find great comfort in their spiritual beliefs or traditions in their faith or religion. Do you?”
	”Here is a place where you can share what you find most comforting to you. There are no right or wrong ways to be spiritually or emotionally comforted!”
How I wish to be remembered	“Almost all of us think about what would happen to us if we died. Most of us have played out our funeral in our minds—who we would want or not want there, what we would want people to say. There is nothing crazy about thinking about this.”
	”Here, you have an opportunity to make sure that your thoughts are heard.”
	”What is most important to you? Do you want there to be a service? If so, what kind? Certain people you would want to be there? Do you have favorite hymns or music that are especially meaningful to you or even food or drinks that you love and would like to be included?”
	”Many AYAs have shared that they wanted something positive to come from their suffering—for example, for doctors to learn from their tumor or cells how to help others who have the same disease as they have. Do you have similar thoughts as these? Most importantly, AYAs have shared that they never want to be forgotten. While those who love you will never forget you for all of their living days, there are ways you can help them feel like they are still doing things for you after you are gone. For example, how you might like to be remembered?”
My voice	“Some AYAs have found completing this page(s) alone to be enough to bring them a sense of emotional closure or peace. But even knowing how to start this page can be really difficult. If you were to want to leave a letter or a message to someone, or some people in your life, who would this be?” [Write a list.] “Who would be the hardest person to write to?” [Create an order.]
	”I can ask you some questions and then write down your thoughts. Would you like to try and see how this feels? We can start with [the least difficult person to write to]. [If yes.] “How about something like:”
	”Writing this letter to you is really hard to do,” or “I am so sorry that I am here writing this letter to you.”
	”You have been so important to me because …”
	”I will especially always remember …”
	”One thing I want you always to know …”
	”In the future, if you ever get very sad …”