Making End of Life Discussions Easier on Patients and Caregivers

Making End of Life Discussions Easier on Patients and Caregivers
Making End of Life Discussions Easier on Patients and Caregivers

One of the most difficult discussions a nurse or family member can have with a terminally ill patient is about end of life (EOL) care. But this subject must be broached as the patient's condition deteriorates and the outcome becomes clearer. Although there is no easy way to have this conversation, the new “Go Wish” tool can help.1

Go Wish — a card game about EOL wishes — was originally created by Coda Alliance to facilitate discussions involving relatives, nursing staff, and other caregivers about advanced care planning in assisted living facilities.2 Go Wish is readily available to be played anywhere, and people of all educational levels — and even those of advanced age who may have limited cognition — can use it without feeling that it is too difficult to understand or too simplistic. There are several ways to play: (1) solitaire, (2) with another patient or a caregiver, (3) in a group, or (4) even online. The idea is not for patients to create an itemized wish list, but rather to focus on goals and priorities. What wishes and ideas are most important to each patient, and for what reasons? This game engages the patient and nurse or caregiver in a discussion about EOL wishes.

The game includes 36 cards, each containing a brief description of a value or goal that patients who are near death consider important. The cards are written in a positive tone and designed in a clear layout that is easy to read. The patient identifies the 10 cards that are most important, which often requires sorting and resorting, as shifting priorities shuffle the cards. In the process of labeling, patients may realize that what had seemed very important in the past, or even a few days ago, is now less urgent. Perhaps now there are some legal issues that have become higher priority because they must be dealt with immediately. According to the card game creators: “The key is to identify the 10 most important things you want to make absolutely sure are clear to anyone who might have to speak on your behalf or make decisions for you.”

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