Medical Oncologist
CION Cancer Clinics
Talking about what matters most to you | CION Cancer Clinics
Talking about what matters means telling your family and doctors what you hope for, what you fear and who should speak for you. With advanced liver cancer, a sudden illness can take away the chance to say it later. This page explains what to cover, how to begin, and why planning ahead does not mean stopping treatment. At CION Cancer Clinics, a multidisciplinary tumour board weighs your liver function and your scans before recommending any treatment.
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Medically reviewed by Dr. Naresh GunduConsultant Medical Oncologist · MBBS, DNB (Internal Medicine), DM (Medical Oncology, AIIMS) · last reviewed October 2026, next review due October 2027
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On this page
- Why talk about what matters while things are still steady?
- What should the conversation actually cover?
- How do you start a conversation nobody wants to begin?
- What do the doctors' terms mean in plain language?
- Will talking about it take away hope?
- What this page cannot tell you
- Common questions about talking through wishes
The short answer
Why talk about what matters while things are still steady?
Because with advanced liver cancer, the moment to decide can arrive suddenly. A bleed, an infection or a spell of confusion can leave the person unable to speak for themselves for days. If the family already knows what that person wants, the hospital decisions in those days are made for them, not around them.
This is not about giving up
Talking about what matters is not the same as stopping treatment. Many people have these conversations and carry on with immunotherapy or a targeted tablet for a long time afterwards. Doctors call it advance care planning. It simply means saying out loud what you hope for, what you fear, and who should speak for you if you cannot.
Who this page is for
It is written for someone with primary liver cancer that is advanced, and for the son, daughter or spouse who is often the one reading. If the cancer in the liver started somewhere else, the same ideas apply, but your treatment choices will be different.
You can change your mind at any time. Nothing said in these conversations is a contract.What to talk about
What should the conversation actually cover?
You do not need to cover all of this at once. Most families get through it in several short talks rather than one long one.
What a good day looks like
Being at home, eating with the family, attending a wedding, staying clear-headed enough to talk. Knowing this lets the team weigh a treatment against what it would cost you in time and comfort.
What worries you most
Pain, being a burden, the cost, dying in hospital, confusion. Fears said out loud can often be planned for. Fears kept quiet usually stay fears.
Who speaks for you
One person, named clearly, who knows your wishes and will tell the doctors. In a joint family this avoids five relatives giving five different answers at the bedside.
Choose someone who will say what you want, not what they want.Where you want to be cared for
Home, a hospital, a hospice, or your native village. Each choice needs different arrangements, so it helps to know early.
Also worth deciding
- Whether you want intensive care if you become very ill
- Faith, rituals or people you want near you
- Money, property and papers that need sorting
Not sure whether this applies to you?
Ask an oncologistGetting started
How do you start a conversation nobody wants to begin?
Pick a calm moment
Not on the day of a bad scan and not in a hospital corridor. A quiet evening at home, with one or two people, works better than a family meeting with everyone present.
Ask, do not announce
"If things got harder, what would matter most to you?" lets the person lead. Some people want to talk at once. Some need a few days. Both are normal.
Bring the doctor in
Ask your oncologist what to expect in the coming months, in plain words. Ask what treatment can and cannot do. CION's tumour board and your oncologist can meet you and the family together for this.
Write it down
A single page, in Telugu or English, listing wishes and the person who speaks for you. Give a copy to that person and keep one with the hospital file.
Come back to it
Wishes change as illness changes. Look at the page again after any big change in treatment or health.
Words you will hear
What do the doctors' terms mean in plain language?
- Advance care planning
- Talking about your wishes for future care, and writing them down, while you can still decide for yourself.
- Goals of care
- What treatment is aiming for right now: longer life, fewer symptoms, or comfort first. The goal can change over time.
- Palliative care
- Care that treats pain, breathlessness, itching and worry. It can run alongside cancer treatment, not only at the end.
- Advance directive or living will
- A written statement of the treatment you would or would not want if you could no longer speak for yourself.
- Nominated person
- The person you choose to speak for you. In India, an advance directive can name one.
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Hope and honesty
Will talking about it take away hope?
Families in India often worry that speaking openly will frighten the patient or make them lose heart. Many patients already sense how ill they are. What frightens them more is being left out of the decisions. Hope can shift from hoping the cancer will go away to hoping for good weeks at home, a grandchild's naming ceremony, or a pain-free night.
When the family wants to keep it secret
Some families ask the doctor not to tell the patient. This is common and comes from love. But a person cannot say what matters to them about a situation nobody has explained. Our page on when the family wants to hide the diagnosis covers this gently.
Who this does not suit, yet
If you were only just diagnosed and the team is still working out the stage and the treatment plan, a full conversation about the end of life may feel too early. Naming the person who speaks for you is still worth doing now. The rest can wait until you have the facts in front of you.
Did you know
Hepatic encephalopathy, the confusion that liver disease can cause, often comes and goes. A person may be clear one week and muddled the next. This is one of the strongest reasons to talk while the person is clear, rather than waiting for a crisis.
Being straight with you
What this page cannot tell you
It cannot tell you how much time there is, or which treatment is right for this stage of your illness. Those answers depend on the tumour, on how well the liver is working, and on how strong the person is. Only the oncologist who has seen the scans and the blood reports can speak to that, and you are entitled to ask.
It is not legal advice
The rules on advance directives in India have been set out by the Supreme Court and have changed over time. How to record one, who must sign it and where it must be kept can change again. Check the current process with a lawyer or with the hospital's social worker before you rely on a written document.
Where to go next
Read about palliative care alongside treatment, and about making decisions for someone who cannot decide, which is the situation this conversation is meant to prepare for.
Questions we are asked
Common questions about talking through wishes
When is the right time to have this conversation?
Sooner than most families think, while the person is clear-headed and not in a crisis. A good moment is soon after the team explains that the cancer is advanced, or after a change in treatment. It does not have to be finished in one sitting, and it can be returned to whenever things change.
Does planning ahead mean stopping treatment?
No. Many people plan ahead and continue immunotherapy, targeted therapy or other treatment. Planning simply means that if a sudden problem leaves the person unable to speak, the family and the doctors already know what they would want. It protects choices rather than closing them.
My father refuses to talk about it. What can we do?
Respect that for now and try again later, in a different way. Some people find it easier to answer one small question, such as who should speak for them, than to talk about everything. Others prefer to talk to the doctor without family present. Never force it.
Should the whole family be present?
Not at first. One or two trusted people usually works better. Once the person has decided what they want, it helps to share it with the wider family, so that nobody is surprised later and the nominated person is not left defending the choice alone.
Can the doctor help us start?
Yes. Ask your oncologist for a meeting to talk about what the illness may bring and what treatment can do. Doctors are used to these talks. At CION, the oncologist can meet the patient and family together and explain things in plain words.
Do we need a lawyer to write down wishes?
A plain written note shared with family and the hospital is useful on its own. A formal advance directive under Indian law has its own process, which has changed over time. If you want a legally recorded document, ask a lawyer or the hospital social worker how it works today.
What if the patient's wishes differ from the family's?
The patient's wishes come first, as long as they can understand their situation. Disagreement is common and painful. A meeting with the oncologist, where everyone hears the same facts, often narrows the gap. A palliative care team can also help families talk it through.
Is palliative care only for the last days?
No. Palliative care treats pain, itching, breathlessness, poor sleep and worry at any stage, and it works alongside cancer treatment. Bringing it in early often makes these conversations easier, because the team is used to asking what matters most.
Your Specialists
Meet CION's liver cancer specialists. Bring your scan reports and liver blood tests.
Our medical and surgical oncologists plan liver cancer care together, weighing the tumour and how well your liver works before choosing surgery, a liver-directed procedure or medicines.
Medical Oncologist
Dr. C. Raghavendra Reddy
MBBS(Gold Medal), DNB(General Medicine), DM(Medical Oncology)(Gold Medal)
Medical Oncologist
Dr. Bharati Devi Gorantla
MBBS, MD(General Medicine), DM(Medical Oncology)(Adyar,Chennai), ECMO, MRCP SCE(UK)
Medical Oncologist
Dr. Owais Mohammed
MBBS, MD (General Medicine), DrNB (Medical Oncology), ECMO, MRCP SCE (Medical Oncology) (UK)
Medical Oncologist
Medical Oncologist
Surgical Oncologist
Dr. Muralidhar Muddusetty
MBBS (AIIMS), MS (Surgery) (AIIMS), DNB (Surgical Oncology), MRCS (Edinburgh)
Surgical Oncologist
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Sources
- National Cancer Institute — Choices for Care with Advanced Cancer
- National Cancer Institute — Palliative Care in Cancer
- World Health Organization — Palliative care
- Liver UK (formerly British Liver Trust) — Hepatic encephalopathy (HE)
This page is general information, not a prescription. Do not change or stop any treatment based on what you read here. If anything is worrying you, contact your own treating team — or call our helpline and we will help you reach the right specialist.
Keep reading
Related pages
Making decisions for someone who cannot decideWhat the family does if the person can no longer speak for themselvesPalliative care alongside treatmentComfort care that runs with cancer treatment, not after itDeciding to stop active treatmentIf the conversation turns to whether treatment is still helpingQuality of life as the treatment goalHow good days at home can shape the plan
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We can meet you and your family together and explain, in plain words, what treatment can and cannot do. One helpline serves every CION centre.