Interactive Decision Aid for Advance Care Planning

DESCRIPTION (provided by applicant): Widely publicized cases such as Terri Schiavo have raised awareness of the importance of advance care planning. However, while promoted through federal law and regulation, emphasis is placed on the completion of an adva nce directive (AD) document rather than on the informed decision making and communication essential to ensuring that end of life care preferences are honored. In fact, there is little evidence that having an AD alone results in improved or preferred care a t the end of life. Consequently, the advance directive (or living will) as a public policy instrument has been called a failed social policy. Recently attention has been redirected to the process of advance care planning. In response, we propose an innovat ive interactive decision aid to help individuals not only make informed decisions about preferred treatment at end of life but also to communicate these preferences and decisions to their health care providers and families. The program will use video to pr ovide visual depiction of several advance stage health states and options for end of life care treatment and to model effective communication with health care providers and family about preferences for care. Template documents for completing an AD and heal th care proxy will be provided for completion immediately or at a later date. The program will be presented on a tablet-PC, with the capability to be web-based allowing the inclusion of these documents in an electronic medical record. No other available pr ogram offers all of these features on a portable platform to maximize and facilitate use across a range of settings The Specific Aims of Phase I are to: 1) develop a content outline for the full program; 2) develop the design and format of the program; 3) develop a script and storyboard for one partial program module; 4) develop this section (prototype) for delivery on a tablet PC; 5) conduct a feasibility evaluation of the prototype; and 6) develop a plan and schedule for production of the full-length prog ram in Phase II. PROJECT NARRATIVE Advance care planning is more than signing a document. It is a process. This interactive decision aide will help individuals not only make informed decisions about preferred treatment at end of life but also to communicat e these preferences and decisions to their health care providers and families. The program will use video to present several advance stage health states and options for end of life care treatment and to model communication with health care providers and fa mily about preferences for care.