Letter-Writing Project Communicates Care Wishes to Healthcare Team, Family

The concept of a “bucket list” is increasingly topical in the fields of palliative care and hospice, and is now becoming technologically relevant with the use of virtual reality.¹ Often nurses use terminology such as “end-of-life wishes” or “goals-of-care conversations” but the purpose is the same: What would your patient like to accomplish before dying? Wyjeyanthi S. Periyakoil, MD, and her colleagues at Stanford University School of Medicine, in Stanford, California, recently reported that having knowledge of a patient’s “bucket list” helps to promote informed decision making by relating each treatment option to its potential impact on the patient’s life and life goals.²

Dr Periyakoil’s group developed a project that addresses the conundrum of how to encourage patients to engage with their physicians and relate what matters most to them in simple and meaningful ways. She wanted to know why doctors and patients were having such a difficult time with these conversations, so she went into the community with medical interpreters to get answers. Those discussions evolved into the Stanford Letter Project, a tool designed to help people write simple letters to their doctors and loved ones about their values and life goals.³ The tool, available in 8 languages, has 3 components:

• What Matters Most allows patients to write about their most significant wishes and concerns: What are their future life milestones? How do they discuss difficult subjects with their family? Whom do they want involved? This component includes simple, basic questions for patients to answer, and the responses can be used to complete an advance directive.

• The goal of the Who Matters Most component is to help all participants complete the “Seven Vital Tasks of Life Review” while they still can. This component involves identifying the key moments and cherished people in one’s life. It covers asking for forgiveness and also giving forgiveness. In this component, the participant learns how to say, “Thank you.” “I love you.” “Goodbye.”

• The bucket list component is I Matter Too. What life experiences do participants want to have? What do they want to do? Where do they want to travel? Do the participants have specific accomplishments they wish to achieve and events they wish to attend?

“Although each section stands alone, the 3 components work together like a jigsaw puzzle to help patients articulate all their wishes about themselves and their loved ones to their care team. This allows us to take these things into account and make better care plans for them. We always talk about patient-centered, family-oriented care. This is how one does that,” explained Dr Periyakoil in an interview with Oncology Nurse Advisor.