Go Wish: a tool for end-of-life care conversations.

The Go Wish card game is an advance care planning tool developed by Coda Alliance to help people have conversations about end-of-life care. Initially, this tool was designed as an easy, entertaining exercise for low-functioning assisted-living facility residents, their family members, and their CNA/nursing assistants (many of whom have limited English language skills.) Use of the tool can be proctored by staff or even a caregiver after minimal instruction. It turns out to be a widely applicable and inexpensive tool to help people discuss end-of-life care. The cards focus the conversations, provide important vocabulary to give voice to patients' needs and concerns, and offer a means for sharing those ideas. The Go Wish tool has developed into professionally designed and printed cards that are boxed as a game set. This paper describes the development of the Go Wish cards and reports on some of the diverse cases in which they have been useful.

Feasibility of discussing end-of-life care goals with inpatients using a structured, conversational approach: the go wish card game.

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.