The Letter Project

Most people don’t realize how much end-of-life counseling that wound care doctors do. It’s not just patients with terminal cancer who have wounds. There are a lot of patients whose wounds are harbingers of death, including extensive calciphylaxis lesions and “Kennedy terminal ulcers” (e.g. rapidly developing deep tissue injury pressure ulcers in the elderly). I often encourage patients to take advantage of hospice care, even though it means they can’t keep seeing me in the wound center, because there’s so much that hospice can do to help patients and families! I didn’t really understand out how wonderful hospice services were until my own Dad was dying. I don’t know what I would have done without them. I have been a huge advocate of hospice ever since.

While it doesn’t seem that end-of-life counseling ought to be the job of the “wound doctor,” the fact is that we may see patients more frequently than their primary care doctor, and we likely spend more time with patients at each visit. These conversations are never easy, and they can be especially hard if the patient’s native language is not English. Houston has one of the most culturally diverse communities in the USA. But, I just discovered a great resource.

The Letter Project

Stanford Medical School enlisted the help of multi-ethnic, multi-lingual patients and their families to create a template that guides patients through the process of making important advanced planning decisions. The template is called “The Letter Project.” It allows patients to talk about what matters to them most on a personal level unrelated to medical care, like how they handle bad news, and then describe their medical decision preferences and give input on the treatment interventions they want and don’t want at the end of life.

The letter is available in several languages including Spanish, Hindi, Mandarin, Tagalog, Russian, Urdu and Vietnamese on the Stanford Medicine Letter Project website.


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