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 If you, like many Americans, have a “bucket list,” your doctor would
be well-served by learning its contents, according to Stanford
University researchers, who say a conversation about these goals
might help guide future care.
Their study, published in the Journal of Palliative Medicine, found
that 91 percent of participants had a “bucket list,” or a list of
things they hope to do before they die.
Researchers say the bucket list conversation is a simple strategy to
help patients consider health decisions. In learning these goals,
clinicians are better suited to promote informed decision-making
when discussing the potential impact of treatment options.
“The number one emotion I see in patients when they are dying is
regret,” said study author VJ Periyakoil, director of the Stanford
Palliative Care Education and Training Program in California.
Her team’s online survey asked more than 3,000 participants
nationwide if they had a bucket list and what was on it, in order of
importance. The average participant was about 50 years old.
Travel was the most prevalent desire. More than 78 percent submitted
travel-related hopes. Among college-educated women, 84 percent had
destinations in mind.
Accomplishing a goal, like finishing a degree and learning to swim,
was important to about 78 percent.
Roughly half hoped to achieve milestones, like getting married,
celebrating an anniversary and reconnecting with old friends.
Desire to spend quality time with friends and family ranked fourth,
followed by hope for financial stability.
Daring activities turned up on 15 percent of lists. Respondents 25
and younger were much more likely to report daring activities, such
as skydiving and swimming with sharks.
Participants who said religion or spirituality was important were
the most likely to have a bucket list.
“Faith allows you to imagine something that cannot be verified,”
Periyakoil explained. “The ability to imagine something is a proxy
for a level of hope even in the face of little evidence. Those are
the people who have things on their list and hope they can do them.”
The researchers did not have participants share their lists with
physicians, nor did they ask physicians for their opinions on the
idea of sharing patients’ bucket lists. Furthermore, the survey did
not target people living with chronic or terminal disease.
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Still, the researchers hope their findings will help shift
end-of-life planning away from an over-reliance on documents.
“If we look at advance directives as the savior of our health
system, it’s not going to work,” Periyakoil said. “I don’t want to
wait for my doctor to tell me it’s time to do my advance directive.
I would rather go to the doctor and say what’s on my bucket list.”
Such a discussion is more intimate than the more sterile
conversations that sometimes accompany advance directives, said
Susan Mathews, a bioethicist, nurse and instructor at Indian River
State College in Fort Pierce, Florida.
“Advance directives are about death; a bucket list is about living,”
Mathews said. “A bucket list, if prepared with a dose of serious
reflection, gets to the heart of our relationship with self and the
others for whom we care.”
Patients should still complete advance directives, she said, but
with periodically updated companion documents that express goals.
Like advance directives, bucket lists can change.
The changing of a patient’s health status is one concern with the
bucket list strategy, according to medical anthropologist Craig
Klugman, who teaches classes on death and dying at DePaul University
in Chicago. “Being asked about a bucket list could create anxiety
that they should have a list and take efforts to fulfill it,”
Klugman said.
Periyakoil said, too often, physicians don’t realize what patients
want from life. If they ask about these desires, they can avoid the
clinical vacuum in which treatment plans are too often made.
“We need patients to understand that it’s their life, have a better
understanding of what they want to do, and understand that medical
procedures are a pathway they are signing into,” Periyakoil said.
SOURCE: http://bit.ly/2ooURnB Journal of Palliative Medicine, online
February 8, 2018.
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