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Stanford Letter Project Helps Patients Talk About End-of-Life Care

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In a NY Times opinion piece last month, Dr. VJ Periyakoil, a nationally recognized leader in geriatrics and palliative care at Stanford University Medical School, unveiled a new campaign to encourage patients to take a more active role in end of life care.

Her team at the Stanford Palliative Care Education & Training Program has created a letter template to make it easier for patients to talk about worse-case and best-case scenarios. The Letter begins with “Dear Doctor” and has easy to fill in blanks and check boxes on issues such as

  • What matters most at the end of life
  • Important milestones they want to reach
  • How bad news is handled in the family
  • Who makes the medical decisions
  • What they DON’T want at the end of life
  • What they DO want

The letter template can be printed, emailed, or filled out by hand. It is important to talk about where the patient might like to be when facing the end—whether that is hospice, home or at a facility. Talking together, asking questions, and creating an end-of-life “game plan” using the information contained in the letter can help ease the uncertainty and ensure that patients plan how they want to live, die and how their hospice caregivers should respond to their needs.

The Stanford letter campaign includes a heartwarming Letter Project Video that shows seniors talking about their wishes and filling out the letter. “I would not want to stay home when I’ve had a lengthy illness to be a burden to my family,” says senior Valia Clausel. “So having this letter would give the doctor an opportunity to do the things that I want to have done as my life is ending or as it ends.” Their refreshingly candid opinions and feelings on their treatment if they were facing end of life issues is meant to encourage participation of their peers.

By clearly writing about what they want their doctor and family to know, patients can help avoid any confusion or miscommunication. Catherine Sweat, another senior interviewed in the video, observed that having a letter would help the families as well. “In a lot of families there’s bickering that goes on depending on how many siblings you have, but when it comes down to it, you want to be respectful to the wishes of your parents.”

Dr. Periyakoil and her palliative care team have created a valuable tool in the Letter Template Project.  These important decisions shouldn’t wait until the last week of a patient’s life. The answers contained in the letter can become useful guideposts for their palliative treatment.

Recommended Reading: The New York Times The End features essays by people who work in fields dealing with death and dying, like medicine, ethics and religion, as well as personal essays by those who have experienced the death of a loved one.

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