Go Wish Cards -- What are they and How to use them with patients and caregivers
An LGBTQIPA2+ Series on Grief, Loss, & Mental Health
by Kelly Hutton, Registered AMFT
Black print over a picture of ocean waves in the background. Two dark purple starburst images over different shades of blue.
One of the hardest things to do in life is to know where to start in planning for the end of your life. Whether it is starting to write your will or specifying what you want to have happen at your deathbed, the initial conversation you as a patient might have among loved ones and medical providers can be a real doozy. And this makes sense – everything may be new, overwhelming, you might have lost sense of control, and it’s taboo in US culture to talk about death, dying, and terminal illnesses. Planning for end of life medical care also requires you to explore lots of personal values, emotions, and anticipatory grief and loss. These could be grieving what you were once able to do before that you cannot do now, financial stresses, and all while having to talk about your medical symptoms and diagnoses.
In my work as a hospice grief counselor, patients would sometimes be reluctant to speak up to ask questions or voice what they need, even though patients, not the doctors or loved ones, are at the center of care. Sometimes this was a cultural decision in which patients and their loved ones believed that loved ones and doctors knew best and more than the patient, which I completely respect and honor culturally. Patients may also have a sense of relief that others are making decisions for them. And a challenge in this case can be doctors and loved ones might need to know more information from the patient in order to make those important decisions. Thus, it can be frustrating without patients explaining what they want to have happen or what they are experiencing mentally and physically.
It is also common for people to be afraid or too tired to speak up about what they need. Perhaps they’ve had bad, invalidating, dismissive, or even traumatic experiences with medical providers in the past – which is very common in LGBTQIPA2+ and BIPOC communities! And it can be especially difficult and frustrating for patients who experience verbal disfluency or have trouble recalling words due to cognitive decline. Patients might be ready to talk, but verbalizing is a struggle!
The good news is that there are some resources out there in English and Spanish that can assist in jump starting overcoming that struggle and initial conversation. As a mental health therapist, I use Go Wish Cards to help patients, couples/partners, chosen families, and caregivers start the collaborative conversation about “I’m at the end of my life. Now what?!” in an approachable, accessible, concrete way. The point of Go Wish is to identify and explore, and specify into two categories 1) what’s very important to you and 2) what’s somewhat important to you in hospice or end of life care. Each Go Wish card in the deck has a different goal, value, or end-of-life wish. You can use them like a solitaire game individually, or you can get two decks, one for the patient and one for a loved one or caregiver, to utilize concurrently. After using them, a lot of times patients and loved ones are relieved to find out that they were more on the same page than they thought they were. And if they are surprised to learn otherwise, it’s an opportunity for patients and loved ones to process what they’ve learned.
Here’s a video of me explaining more about the cards:
Here’s an example of how patients can set up their own solitaire/solo version of the cards:
Here’s an example of how to set up the dual-deck conversation with patients and their loved ones:
Also, there is no requirement to purchase these cards in order to use them. Go Wish has a free online solitaire version in which you use the mouse or use a finger with touch screens to click on and drag the cards to “very important” or “somewhat important” categories. My medical social worker colleagues at hospice care found the electronic version very helpful in facilitating conversations one-on-one with patients while coordinating case management and establishing care plans. Here’s a screenshot of the free online version of Go Wish found at gowish.html:
You can also make your own decks. At one point, when my cash flow was low in Marriage and Family Therapy (MFT) graduate school, I made my own 3x5” flash-card decks in English and Spanish based upon the ones in the electronic version. It took more time than I thought it would to complete them, but they worked, too. All you have to do is write down what’s on each of the cards you click on in the online version.
To be very clear, neither Waves, A Psychological Corporation nor I are affiliated with Go Wish. They did not pay me or anyone at Waves, A Psych Co to mention or suggest Go Wish cards. They don’t even know I’m writing this blog! These cards are merely a tool that I have used as a grief, loss, and bereavement therapist. They’ve been remarkably helpful with clients.
And remember, Waves’ clinicians are on your team, too! Kelly’s own wish for you is that this resource helps mitigate stress in your process at the end of life and help you to regain or strengthen your own sense of agency. And you and your loved ones, caregivers, friends, and chosen family don’t have to do this alone. I’ll walk this path with you and all who love you.
Resources
The CODA Alliance. Go Wish. https://codaalliance.org/go-wish/
Menkin E. S. (2007). Go Wish: a tool for end-of-life care conversations. Journal of palliative medicine, 10(2), 297–303. https://doi.org/10.1089/jpm.2006.9983
Osman, H., El Jurdi, K., Sabra, R., & Arawi, T. (2018). Respecting patient choices: using the 'Go Wish' cards as a teaching tool. BMJ supportive & palliative care, 8(2), 194–197. https://doi.org/10.1136/bmjspcare-2017-001342