Oncology Rounds

What 3,000 patients' 'bucket lists' revealed about providing meaningful end-of-life care

By Deirdre Saulet and Soleil Shah

The concept of a "bucket list" may be an approachable way to engage cancer patients in discussions about end-of-life care. According to a new study published in the Journal of Palliative Medicine, a Google search for "bucket list" turned up nearly 84 million results compared to 4.5 million results for the term "advanced directives."

"Patients don’t see the relevance of an advance directive," said one of the study’s authors, VJ Periyakoil, M.D. "but they do see the relevance of a bucket list as a way to help them plan ahead for what matters most in their lives."

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Bucket lists can help drive treatment decisions and spur more in-depth end-of-life care conversations

The study found that 91% of the 3,065 people they surveyed had a bucket list. Common themes included traveling, accomplishing a personal goal, hitting specific life milestones (e.g., seeing kids get married), spending quality time with friends and family, achieving financial stability, and doing a daring activity (e.g., going deep sea fishing).

Armed with this information, providers could better tailor treatment to meet the needs of their patients. For example, providers should encourage patients with a terminal illness to complete a bucket list, and then use it as a tool to guide treatment decisions and help them find fulfillment in their last few months or weeks of life. Providers could adjust visiting policies to allow their patients to spend more time with their families, discharge their patients early to allow them to attend an important event, or even deploy virtual reality to help patients relive memorable experiences.

Providers can also ask about their patients’ bucket lists as a starting point for more in-depth conversations about end-of-life care preferences, which are notoriously challenging to initiate. In a 2015 study, 99.99% of doctors reported experiencing barriers to end-of-life discussions.

The Stanford Letter Project provides tools to record patient preferences about their health care

In 2015, researchers at Stanford University created the Stanford Letter Project, which includes letter templates to help patients easily explain their end-of-life desires to providers. These tools are broken into three components for patients: “What Matters Most?”, “I Matter Too”, and “Who Matters Most?” Each component includes questions that can be assembled into a letter that informs providers about what matters most to their patients regarding their future health care, as well as experiences or achievements a person hopes to have or accomplish in their lifetime.

Cancer programs should embrace creative strategies to elicit end-of-life preferences from patients

To improve the quality of care they provide while decreasing costs, cancer programs are thinking critically about end-of-life care. How can you provide the best care to patients and their caregivers at the end of their lives, and how can you ensure that patients aren’t getting expensive or intrusive care that doesn’t provide clinical benefits? To address these questions, cancer programs should use creative strategies, like bucket lists or Stanford’s letter templates, in addition to integrated palliative care, to initiate conversations about end-of-life care with patients.



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