Journal of Pain and Symptom Management
Volume 39, Issue 4 , Pages 637-643, April 2010

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

  • Azadeh Lankarani-Fard, MD

      Affiliations

    • VA Greater Los Angeles Healthcare System, Los Angeles, California, USA
    • David Geffen School of Medicine, UCLA, Los Angeles, California, USA
    • Corresponding Author InformationAddress correspondence to: Azadeh Lankarani-Fard, MD, VA Greater Los Angeles Healthcare System, 11301 Wilshire Boulevard, Suite 111A, Los Angeles, CA 90403, USA.
    • ,
  • Herschel Knapp, PhD, MSSW

      Affiliations

    • VA Greater Los Angeles Healthcare System, Los Angeles, California, USA
    • ,
  • Karl A. Lorenz, MD, MSHS

      Affiliations

    • VA Greater Los Angeles Healthcare System, Los Angeles, California, USA
    • David Geffen School of Medicine, UCLA, Los Angeles, California, USA
    • ,
  • Joya F. Golden, MSW

      Affiliations

    • VA Greater Los Angeles Healthcare System, Los Angeles, California, USA
    • ,
  • Anne Taylor, BA

      Affiliations

    • VA Greater Los Angeles Healthcare System, Los Angeles, California, USA
    • ,
  • Jamie E. Feld, BA

      Affiliations

    • VA Greater Los Angeles Healthcare System, Los Angeles, California, USA
    • ,
  • Lisa R. Shugarman, PhD

      Affiliations

    • RAND Corporation, Santa Monica, California, USA
    • ,
  • Demetria Malloy, MD

      Affiliations

    • VA Greater Los Angeles Healthcare System, Los Angeles, California, USA
    • David Geffen School of Medicine, UCLA, Los Angeles, California, USA
    • ,
  • Elizabeth S. Menkin, MD

      Affiliations

    • San Diego Hospice, San Diego, California, USA
    • Coda Alliance, San Jose, California, USA
    • ,
  • Steven M. Asch, MD, MPH

      Affiliations

    • VA Greater Los Angeles Healthcare System, Los Angeles, California, USA
    • David Geffen School of Medicine, UCLA, Los Angeles, California, USA

Accepted 29 August 2009.

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.

Key Words: Advance care planning, end-of-life care, palliative medicine, Go Wish cards

 

PII: S0885-3924(10)00126-0

doi:10.1016/j.jpainsymman.2009.08.011

Journal of Pain and Symptom Management
Volume 39, Issue 4 , Pages 637-643, April 2010

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