The Stanford Letter Project

Remember that line from the song “My Way” immortalized by Frank Sinatra, “[r]egrets, I’ve had a few….” For some people, telling their families how they feel about them, especially at the end of life, can be daunting and not having done so sooner may be a regret.  An ethical will or even the 5 Wishes document can be helpful in explaining things in writing that are too difficult to say. 

I was interested in learning about the Stanford Letter Project with its goal “[t]o help, empower and support all adults to prepare for their future and take the initiative to talk to their doctors and their friends and family about what matters most to them at life’s end.” So what does this project do? The website explains:

All of us will face the end of life one day. Contemplating one’s own death and doing some basic preparatory work is certainly not an easy task. However, the emotional, physical and the financial toll of not doing so is exorbitantly high. People who do not clearly document their wishes and preferences for care at the end of life are often subjected to futile medical treatments that they neither seek nor benefit from. Their families are burdened by the medical bills accrued from the numerous ineffective treatments many patients get at the end of life. In fact, a large research study showed that 62 % personal bankruptcies are due to medical expenses. Over 75% of the people who became bankrupt due to medical expenses had some form of health insurance (i.e., having health insurance does not protect you and your family from medical expense related financial crises).

A major reason for all these problems is that most Americans don’t like to talk about and prepare for the last phase of life. Our research has shown that  people find it extremely difficult to discuss this important issue both with their doctors and with their friends and family.

We started the Stanford Letter Project in 2015 based on many years of research and discussions with people from various cultural and social backgrounds. We conducted interviews and focus groups in multiple languages with people in the community and talked to numerous patients and their family members as well as health professionals. We found that while almost all doctors agree that it is important for them to have end-of-life conversations with their patients, most doctors struggle with these conversations. We also found that patients from all ethnic backgrounds feel that is is very important for them to have end of life conversations with their doctors and their family members. However, patients do not quite know how to initiate these conversations.  

Based on these research findings, we created the Letter Project tools to help you write letters about your wishes for care in the future.

These letter templates are specifically designed to help you voice the key information needed to help you prepare for the future.  Use the Stanford Letter Project tools today to write to your doctor, your friends, and your family. It is free, easy, and extremely important.

The website includes some video letters to friends and families, as well as to doctors.  There is also a “template” for an advance directive generated from a user’s responses to questions as well as a “life review letter” template.

The goal of our Friends and Family Letter template is to help all Americans complete the seven vital tasks of life review while they still can. We designed this project based on years of clinical experience caring for thousands seriously ill patients and families. … The template was pilot-tested and refined after extensive discussions with patients from diverse cultures and traditions to identify the seven tasks of life review.

There are 7 tasks for a life review, which include:

1. Acknowledge the important people in your life…

2. Remember treasured moments from your life….

3. Apologize to those you love if you hurt them….

4. Forgive those who love you if they have hurt you…

5. Express your gratitude for all the love and care you have received….

6. Tell your friends and family how much you love them… [and]

7. Take a moment to say “goodbye.

Check out the website.