Evolution and Purpose

0061 - GW pic

Reactions to Elephant in the Rööm™:


“… a collective WOW!  … Elephant in the Room was thought-provoking and well designed. We liked the questions. They pointedly addressed many different areas that the average person might not consider when thinking about how their lives might change as they approached the end of their lives. As Kim [Eileen Kim, an internist at Kaiser Permanente in Oakland, California] said, “It gets to the meat of the matter” — the nitty-gritty details that become terribly important when we are seriously ill.  – Seven Ponds blog (read full review here)


“My brother-in-law had a stroke within a year of my father-in-law’s passing. Fortunately, we knew my father-in-law’s wishes because of his Living Will. After my brother-in-law’s stroke, my husband and I became his Powers of Attorney and because of my knowledge of Elephant in the Room, we were able to discuss his wishes and have them put into writing on the POA. Your cards were invaluable resources in dealing with such difficult times.” – Stephanie J. (Selinsgrove, Pennsylvania)


“I like Elephant in the Room because the cards visually help the family work on the issues together as opposed to working on each other.” – Stephen G. (Vancouver, Canada)


Comments from the Psychosocial Care in End-of-Life Workshops in South Africa (with Dr. Nelia D.):

“…now I’m sure I will understand my patients and their family much better.”

“Now I know what I still need to do before I die.”

“The questions really made me think.”

“I never thought that thinking about my own death can bring me closer to my patients. Excellent!”


Elephant in the Rööm™ was created by a husband and wife team (a registered nurse and social worker, respectively) to help individuals, families and groups think about healthcare needs and discuss decisions they would make in a variety of physical and emotional states. The purpose of Elephant in the Rööm™ is to help people begin meaningful conversations regarding the kinds of care they want when health conditions change or even as natural aging occurs.

Many people are eager for advanced care planning discussions, but conversations are often delayed until times of acute illness or medical crisis. Research has found that some healthcare professionals are either uncomfortable with having end-of-life discussions or do not have adequate time to have these conversations.

Delaying these important conversations until a disease is diagnosed or a trauma occurs puts an added burden on patients, and more often on their loved ones as surrogate decision-makers, who may be asked to quickly contemplate what treatment or care the patient would want in that moment. A medical crisis or trauma can raise the level of emotional chaos disabling rational thought and decision-making ability.  Research shows that earlier decision making can reduce the emotional burden that loved ones experience when they are forced to make decisions for someone else.

By using Elephant in the Rööm™ each individual can confirm their preferences, enhance communication with their family and healthcare team, provide time for family and other loved ones to understand decisions, and relieve uncertainty or guilt about decision-making. These are personal conversations, not medical consultations and they will require a loving commitment of time and attention from all involved. Elephant in the Rööm™ can help people begin these important personal conversations.

Elephant in the Rööm™ was designed to be used when people are healthy (or relatively so) and able to contemplate their healthcare needs in an abstract way.  This will minimize angst and anxiety that can sometimes arise in talking about medical trauma, dying and death. Elephant in the Rööm™ can also be used by healthcare providers with their patients by selectively choosing certain categories or particular cards to target more immediate conversation.