One of my favorite tools for Advance Care Planning discussions is the Go Wish card "game" provided by the nice folks over at the CODA Alliance. The cards were developed by hospice physician Elizabeth Menkin, M.D., based on review of the literature on what issues are most important to real people who are faced with end of life decisions. The items on the cards were derived in part from results of a survey reported by Steinhauser, K. E. et al. "Factors Considered Important at the End of Life by Patients. Family, Physicians, and Other Care Providers." JAMA. 2000;284:2476-2482
I'm such a fan of these simple cards that I did a podcast with Dr. Menkin explaining how the game works, using myself as the guinea pig. You can listen to my own advance care planning discussion with her explaining how the game works: (download podcast, mp3, 40:32). If you have questions about anything in that podcast, send me a tweet.
The game is a set of 36 cards, each with a short statement of things people often cite as being important to them in the last weeks or months of life. The format is similar to playing cards, and referring to it as a "game" helps make it less scary to think about the subject. You can use the cards either in "solitaire" mode or with another person. If you are an end-of-life professional such as a hospice or palliative care worker you can easily introduce the game to someone in just a few minutes. I've found that people warm up to the cards quickly and have no problems using them to prime the pump in care planning. Unlike filling out forms, the cards stimulate conversations that uncover values and preferences for end of life care.
Coda Alliance sells the cards to the general public and to health professionals. The cards have been extensively field testing in a wide range of settings, including community meetings, family gatherings, and in church lunch-and-learn groups. When exposed to the cards, people often want to have a set to take home so they can "play the game" with elderly parents or their young adult children, to help them prepare for their possible role as a health care agent.
The game is useful for social workers, health educators, or chronic conditions case managers meeting with patients and their loved ones trying to get conversations started about end of life care. Hospice social workers use the cards to stimulate discussions about what the patient still may hope for.
The starter game comes with two packs of cards in contrasting colors and instructions for using the cards individually or in pairs. Card packs may also be purchased in bulk.
Once you have had your conversation you can record it using an Advance Directive Form such as the California forms provided for free by CODA.
Les says "Check them out!"
