Bucket lists can be a welcome ice breaker

Bringing up the topic of a care plan can often be challenging for a GP, but talking about bucket lists can often help

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“Have you ever wanted to visit the pyramids? Run with the bulls? Write a book?” These may be the kinds of questions at the heart of better personalised healthcare, according to a US study.

While the importance of discussing goals-of-care is well recognised in the medical community, the uptake of strategies such as advanced care plans is notoriously low.

But authors of a new study say that asking patients about their bucket lists, or goals and dreams they hope to achieve in their lifetimes, is a simple and well-received tool to help clinicians anticipate their treatment needs.

The concept of bucket lists, which were popularised in the 2007 film with Morgan Freeman and Jack Nicholson, is ubiquitous. Almost all of the 3000 people surveyed as part of clinical associate professor of medicine VJ Periyakoil’s study had a bucket list.

The geriatrician and palliative care doctor said she routinely asked patients if they had a bucket list, saying it provided a hopeful and positive framework for patients to think about their life goals, health and mortality.

“It’s important for physicians to talk to patients and find out what actually motivates them,” she said.

“Telling a patient not to eat sugar because it’s bad for them doesn’t work nearly as well as saying, for example, if you are careful now, you will be able to splurge on a slice of wedding cake in a few months when your son gets married.”

As important as end-of-life discussions were, fewer patients were familiar with terms such as “advanced care plans” or “advanced care directives”, and they might not understand the consequences of their treatment choices, the authors wrote.

“Clinicians, on the other hand, are trained to focus on disease management within a purely medical context and do not often ask about the patient’s short-term and long-term life goals, let alone elaborate on the impact of the treatment(s) on such goals,” they added, saying this communication gap could lead to treatment that undermined the patient’s life goals.

“I had a patient with gall bladder cancer,” Professor Periyakoil said. “He was really stressed because he wanted to take his family to Hawaii but had treatment scheduled. He didn’t know he could postpone his treatment by two weeks.”

The survey found that bucket list topics fell into six main categories, the most popular being the desire to travel, followed by the desire to accomplish a personal goal, desire to achieve specific life milestones, desire to spend quality time with friends and family, desire to achieve financial stability and desire to do a daring activity.

Spending quality time with friends and family was most popular among participants aged 63 and older, while daring activities were big among those under the age of 26.

Associate Professor Charlotte Hespe, head of General Practice at the University of Notre Dame, welcomed the suggestion to use bucket lists as a conversation-starter, saying it was “great concept” that framed these conversations in a more positive light.

“As a GP, I sometimes find it difficult to have a conversation about a care plan with a patient of mine who’s well and healthy in their 60s or 70s,” she said. “But it doesn’t matter what age you are, [discussing a bucket list] resonates on some level.”

J Palliat Med; online 8 February