COMMENTARY

End-of-Life Travel: Beyond the Bucket List

Betty R. Ferrell, PhD, RN

Disclosures

August 09, 2019

Ask people what they'd like to do before they die, and many will answer "travel." It might be a dream vacation, or a trip to somewhere they've never been, but the number one desire of those with travel on their end-of-life bucket list is to return to the place of their birth.[1]

This isn't a bucket-list wish to visit one's home city, state, or country as a tourist. Many seriously ill patients have a more specific reason to go home when facing the end of life—it's where they prefer to die.[1]

In many cases, fulfilling this wish requires medically assisted travel, the arrangements for which can involve the advice of healthcare providers, including palliative care clinicians. A recent article[1] addressed the practical considerations in arranging travel for patients with life-limiting illnesses.

For a start, Aisporna and Erickson-Hurt recommend that bucket-list desires be integrated into goals-of-care conversations.[1] Rather than assuming that patients with a terminal diagnosis are too sick to travel, that they should focus only on their treatment, or that they'd prefer to remain at home with loved ones, palliative care clinicians need to ask about travel early enough to avoid missing the opportunity entirely.[2,3,4] This can happen, for example, if aggressive treatments impair the patient's functional status, or if the patient dies before having the chance to travel.

How does an ill or dying person travel? The three chief options are by critical care air ambulance, with a voluntary (nonmedical) companion, and with a medical escort. To facilitate medical travel, palliative care professionals can explain these travel options; discuss the pros and cons, including potential obstacles; and assist with travel arrangements.

It might not be on everyone's bucket list, according to the authors, but when medical travel is important to the patient's well-being, sense of fulfillment, and control over the dying process, eliciting and supporting these wishes is the foundation of patient-focused palliative care.[1]

Viewpoint

Palliative care professionals and all clinicians involved in caring for seriously ill patients are well aware of the common "bucket list" wish to travel when patients are facing the end of life. The article by Aisporna and Erickson-Hurt is a welcome resource for clinicians who aren't certain how to start the conversation or how to respond when a seriously ill patient expresses a desire for travel.

The four case studies presented by the authors illustrate key considerations in planning medical travel, including useful questions to assess patient needs and practical tips for successful planning. Factors to consider include the patient's cognitive status, potential physical and emotional stresses of travel, coping with a journey's unfamiliar environments, the availability of medical supplies and medications, and the patient's specific needs for medical care during travel. Overcoming the barriers imposed by airlines may require the input of medical professionals.

Assessing and supporting bucket-list wishes for travel is an important aspect of meeting the patient's goals. Being well-prepared to support travel can be a great service to patients at the end of life.

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