“It's About the Conversation”: A Multidisciplinary Intervention to Support Advance Care Planning (S808)

Abstract

•Understand how the “Go Wish” card game is played.•Describe how various forms of media can be used to advertise and effectively engage patients, caregivers, and staff. A recent California Healthcare Foundation study found 60% of Californians highly valued “making sure their families are not burdened by tough decisions about their care.” However, less than 50% have communicated end-of-life (EOL) wishes to their surrogate decision maker. 82% say it is important to have EOL wishes in writing, but only 23% say they have done so. At City of Hope (COH), the advance directive (AD) completion rate is less than 15%. The event should engage patients and staff in advance care planning (ACP) conversations and increase AD completion. A multi-disciplinary team designed a social media advertised 4-hour interactive event. Over 40 staff and volunteers facilitated individualized ACP conversations, private consultations with social workers, showed novel COH ACP videos, provided multi-lingual ACP literature and AD documents available for completion with complimentary notary support on-site. Over 300 people attended. 47 ADs were completed (24 by patient/caregivers, 23 by COH staff). 29 Go Wish games were facilitated (2 in Spanish). Of 52 attendees who completed exit evaluations, 44% were patients, 31% staff, and 11% were caregivers. Respondents reported the event increased their comfort and likelihood of having ACP conversations with others. Importantly, 38 of the 52 surveyed did not have an AD prior to attending the event. Of those 38 attendees, 18 of them completed an AD at the event (or 47%). ACP is an all too often avoided conversation that results in increased distress of patients, families, and providers. By proactively designing opportunities for facilitated conversations in dynamic and public arenas, fear and stigmas are diffused and the true focus and intent of discovering what people wish so the medical team, surrogates, and family can ensure their values are honored and met.