1How do I order a set?
To order cards please go to our order page. Proceeds from sales support Coda Alliance's public education programs.
2Why did Coda Alliance invent this game?
Development of the Go Wish game was made possible by a grant from Archstone Foundation. Production of the cards was supported by a community contributions grant from Kaiser Permanente. Coda was funded in 2005 -2006 by Archstone Foundation to develop and test a program to educate assisted living residents, their family members, and assisted living facility staff about end-of-life care options and advance care planning. The Go Wish game was developed within this project, to fill a need for a way to stimulate discussion that would focus in a positive way on values and wishes about end-of-life care. It was also developed as an effective tool for elderly people with limited cognition, and for people with limited literacy and limited skills in the English language, without seeming too simplistic for those with higher education.
3How does the game work?
The game is a set of 36 cards, each card with a short statement of things people often cite as being important to them in the last weeks or months of life. To play the game (in the 'solitaire' mode) the individual sorts the cards and ranks priorities about what's important to them, and then discusses or explains to a friend or family member why they made the sort the way they did. The instruction sheet for the game gives other ways to play it in pairs or groups. The point of the game is not to create a written list of "what I want," but to stimulate conversations about what is important and why. Many people remark that when they play the game several times, the way they sort the cards changes a bit, but that this helps them refine their thinking about what their values are and how those values would apply in different situations.
4Where have the cards been field tested?
The items on the cards were derived in part from results of a survey reported by Steinhauser, K. E. et al. "Factors Considered Important at the End of Life by Patients. Family, Physicians, and Other Care Providers." JAMA. 2000;284:2476-2482 The cards were initially developed as a tool for promoting discussions of values and wishes for advance care planning for assisted living facility residents, their family members and the facility nursing assistants/CNA's. We revised the original set of cards to be more readable for elderly residents with short attentions spans, and in simpler language for nursing aides who have limited literacy and limited skills in English. Coda Alliance board members and volunteers have also tried them out on our friends, family members, neighbors, physicians, nurses, and social workers at the TPMG regional dementia conference, the Kaiser Ethics conference in March 2005, the Conversations at the End of Life course at Santa Teresa, and the EPEC conference at Tenaya Lodge. Coda Alliance has used them in a variety of community settings such as church lunch-and-learn groups and senior centers. Individuals who have mild dementia and poor eyesight can participate in the game by expressing how much they agree with the statement on each card when they are read aloud. Those with higher intellectual capability use the statements on the cards as discussion starters on the various meanings and implications of the statements and when they might agree or disagree.
5Who would use the game?
Coda Alliance is selling the cards to the general public and to health professionals. In health education classes on advance directives and advance care planning, the game helps patients and their potential surrogates compare and discuss priorities that they hold in common, and to discover where their priorities differ. Community members have used these in community meetings, a synagogue social action committee, at family gatherings, and in church lunch-and-learn groups. In all of the groups where they have tried out the cards, people often want to have a set of cards to take home and play the game with their elderly parents or their young adult children, to help them prepare for their possible role as health care agent. The game is useful for social workers, health educators, or chronic conditions case managers meeting with patients and their loved ones trying to get conversations started about end of life care. Hospice social workers use the cards to stimulate discussions about what the patient still may hope for. With a patient who did have anyone they would want to name as a surrogate, I used the game to give me, the physician, a chance to understand what goals and values were guiding the treatment decisions the patient was making. He also found it helped him articulate his priorities and concerns.
6How well do the cards work?
The goal of the tool is to facilitate discussions, and for the end result of getting people to think and talk about positive values and goals for having the best end of life possible, they seem to be wildly successful. When I have used these in large groups, the room reliably erupts in lively conversations. Just about every group I have presented this exercise to has wanted to have the cards to keep. In one large group, where I emphasized that we did need to collect the packs for re-use, there was nonetheless a 30% attrition rate - a testament to this being a desirable commodity.
7What is the design of the cards?
The cards are attractive and durable. The cards come in packs with the possibility of 4 different edge colors (so in groups, if a card drops on the floor, it is easier to get it back with the correct pack), and are die-cut with rounded edges so they are comfortable to handle. A set comes with two packs with contrasting colors. Instructions for using the cards are included in each pack for individuals, couples, and in groups to stimulate thought and discussion. Printing of the final product was made possible and affordable by a Kaiser Permanente community contributions grant to Coda Alliance.