Feasibility of Discussing End-of-Life Care Goals with Inpatients Using a Structured, Conversational Approach: The Go Wish Card Game

• Published in: Journal of pain and symptom management 2010-04, Vol.39 (4), p.637-643
• Main Authors: Lankarani-Fard, Azadeh, MD, Knapp, Herschel, PhD, MSSW, Lorenz, Karl A., MD, MSHS, Golden, Joya F., MSW, Taylor, Anne, BA, Feld, Jamie E., BA, Shugarman, Lisa R., PhD, Malloy, Demetria, MD, Menkin, Elizabeth S., MD, Asch, Steven M., MD, MPH
• Format: Article
• Language: English
• Subjects: Adult; Advance care planning; Aged; Aged, 80 and over; Anesthesia & Perioperative Care; Biological and medical sciences; California; Card games; Communication; End of life decisions; end-of-life care; Feasibility; Feasibility Studies; Female; Games, Experimental; Go Wish cards; Hospitalization; Humans; Male; Medical sciences; Middle Aged; Pain Medicine; Palliative care; Palliative Care - psychology; palliative medicine; Patient Participation - methods; Patient Participation - psychology; Pharmacology. Drug treatments; Physician-Patient Relations; Spirituality; Terminal Care - psychology
• ISSN: 0885-3924; 1873-6513
• DOI: 10.1016/j.jpainsymman.2009.08.011

Abstract Establishing goals of care is important in advance care planning. However, such discussions require a significant time investment on the part of trained personnel and may be overwhelming for the patient. The Go Wish card game was designed to allow patients to consider the importance of common issues at the end of life in a nonconfrontational setting. By sorting through their values in private, patients may present to their provider ready to have a focused conversation about end-of-life care. We evaluated the feasibility of using the Go Wish card game with seriously ill patients in the hospital. Of 133 inpatients approached, 33 (25%) were able to complete the game. The “top 10” values were scored based on frequency and adjusted for rank. The value selected of highest importance by the most subjects was “to be free from pain.” Other highly ranked values concerned spirituality, maintaining a sense of self, symptom management, and establishing a strong relationship with health care professionals. Average time to review the patient's rank list after the patient sorted their values in private was 21.8 minutes (range: 6-45 minutes). The rankings from the Go Wish game are similar to those from other surveys of seriously ill patients. Our results suggest that it is feasible to use the Go Wish card game even in the chaotic inpatient setting to obtain an accurate portrayal of the patient's goals of care in a time-efficient manner.