Pre­par­ing for the end— it’s in the cards

Modern Healthcare - - OUTLIERS ASIDES & INSIDES -

It’s not ev­ery day that a doc­tor at a lead­ing aca­demic med­i­cal cen­ter re­cruits strangers to sit in cir­cles and play games about “the end.” So re­searcher Dr. Lau­ren Van Scoy had to get used to skep­ti­cism.

“They look at me cross-eyed, like I am ab­so­lutely nuts,” says Van Scoy, as­sis­tant pro­fes­sor of medicine and hu­man­i­ties at Penn State’s Her­shey Med­i­cal Cen­ter. She has been study­ing whether the card game My Gift of Grace can help peo­ple to not only think about death and dy­ing, but plan for it.

For many, just hear­ing the words “end of life” and “ad­vance plan­ning” are a buzz kill. Even older adults aren’t very fo­cused on it: Only about one-third have an ad­vance di­rec­tive ex­press­ing their wishes for end-of-life care, ac­cord­ing to es­ti­mates.

Last week dur­ing the Amer­i­can Tho­racic So­ci­ety con­fer­ence in Den­ver, Van Scoy pre­sented find­ings from two small stud­ies that showed the game suc­ceeded in get­ting fam­i­lies, com­plete strangers and even some “frat boy types” to think about death in ways that prompted laugh­ter rather than dread.

Seventy-four per­cent of the par­tic­i­pants went on to per­form at least one ad­vance­care plan­ning ac­tiv­ity within 10 weeks, such as cre­at­ing an ad­vance di­rec­tive or living will, or seek­ing out nurs­ing home in­for­ma­tion.

The deck of 42 cards con­tains heavy open-ended ques­tions such as: What do you fear more: experiencing the worst pain of your life or not get­ting the chance to say good­bye to a loved one? And, what do you want your doc to fo­cus on more, qual­ity or quan­tity of life?

But the key to suc­cess was in­ter­spers­ing lighter queries. For ex­am­ple, what meal would you want on your last day alive? And, what kind of mu­sic would you like played at your fu­neral?

“The fu­neral ques­tion was hi­lar­i­ous,” Van Scoy said. “Peo­ple came up with playlists, like ‘I want the boys choir to sing a ver­sion of Michael Jack­son’s ‘I’ll Be There’ and then switch into a Bey­oncé tune.’ ”

Re­searchers found that the My Gift of

Grace card game did prompt peo­ple to take steps to­ward end-of-life plan­ning.

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