COMMENTARY

How 'Bucket Lists' Can Help in Serious Illness

Betty R. Ferrell, PhD, RN

Disclosures

September 11, 2018

Who Has a Bucket List, and What's on It?

The concept of a "bucket list" is widely known in popular media and literature as a list of activities, goals, or achievements that an individual hopes to accomplish before the end of his or her life. In a recent study, Periyakoil and colleagues[1] explored the idea of a bucket list as a tool for clinicians to better understand the priorities of patients who face serious illness.

A national online survey with more than 3000 participants provided qualitative data for the study. The survey asked whether respondents had a bucket list, and what was on it. It turns out that 91% of the respondents had bucket lists.

A qualitative analysis of data from 40 randomly selected respondents with bucket lists yielded six themes for bucket lists. These were, in descending order of frequency:

  • A desire to travel (78.5%);

  • The accomplishment of a personal goal (78.3%);

  • The achievement of life milestones (51%);

  • Spending quality time with friends and family (16.7%);

  • A desire for financial stability (16.1%); and

  • A desire to do a daring activity (15%).

People who identified faith or spirituality as being important in their lives were most likely of all respondents to have a bucket list (95%). Older respondents were more likely than younger respondents to include "spending time with friends or family" on their bucket lists. Young respondents were more likely to want to do something daring or risky before they die.

A major conclusion of this study was that awareness of a patient's priorities and life goals can assist in decision-making about disease and treatments. The bucket list can serve as a framework to engage patients in these healthcare decisions.

The investigators suggest that clincians might be missing the boat with respect to understanding what matters most to patients. Goals-of-care discussions typically focus exclusively on end-of-life treatment choices and fail to capture the patient's hoped-for milestones, activities, and accomplishments. Knowing how patients wish to live can help clincians understand the potential impact of treatment options on the patient's goals.

Viewpoint

A growing body of literature supports the importance of assessing patients' individual life experiences and values to provide the most appropriate care in serious illness.[2,3,4] Numerous curricula have been designed to teach clinicians strategies for assessing patient goals, their understanding of treatment choices, and the potential impact of illness on quality of life.

Although the participants in the bucket list survey were not necessarily ill or facing the end of life, it is significant that each of the six identified themes are areas that can be profoundly affected by disease and treatments. Inviting patients to share their bucket lists may be an important strategy to elicit their stories and to be guided by their goals, particularly for those at the end of life.[5,6]

Comments

3090D553-9492-4563-8681-AD288FA52ACE
Comments on Medscape are moderated and should be professional in tone and on topic. You must declare any conflicts of interest related to your comments and responses. Please see our Commenting Guide for further information. We reserve the right to remove posts at our sole discretion.
Post as:

processing....