Abstract
Dear Editor:
Advance care planning (ACP) helps to ensure that patient preferences are honored at end of life; yet, less than a third of older adults complete advance directives. 1 The Death Over Dinner movement 2 normalizes ACP conversations over dinner with others. Facilitators engage guests in sharing end-of-life experiences and care preferences.
In conjunction with the 2017 National Healthcare Decisions Day, we hosted a Death Over Dinner at a senior center to increase ACP in our community. After the event, we conducted a survey to assess participant response. The project was approved as a quality improvement initiative. An invitation to the Death Over Dinner event was sent to 4000 senior center members through e-mail. The event quickly reached capacity and a waiting list was created in case of cancellations. Sixteen faculty, staff, and students from the academic medical center were facilitators for eight dinner tables. Students with majors in healthcare fields were included as facilitators to encourage intergenerational discussion as well as to train future healthcare providers on how to facilitate ACP. All facilitators completed the predeath over dinner homework. An e-mail link to the survey was sent to guests one week after the event, with one follow-up reminder. The survey included 12 questions, focused on reasons for participation, advance directive status, and demographics. Responses were choice-based, Likert scale, or open-ended text boxes.
Thirty-seven individuals took part in the Death Over Dinner event and all (100%) completed the survey. Most participants were female (70%), white (81%), and between 57 and 87 years (average 70 years). Most participants felt it was important to have an advance directive and they were interested in discussing the topic with others. The majority (68%) had an advance directive, but only 16 (43%) had shared it with their healthcare provider. Seven participants (19%) indicated they planned to complete an advance directive within the next month. Comfort level with discussing ACP was high (8.8/10) as was satisfaction with the Death Over Dinner event (8.1/10). In particular, many participants enjoyed the intergenerational aspect of the Death Over Dinner event and talking to future healthcare providers about ACP. Several participants expressed the desire to participate in a facilitated Death Over Dinner event with family members and/or friends.
Similar to other Death Over Dinner events, 3 this event was well received and can serve as a tool to engage community members in ACP. Future initiatives related to ACP should not only encourage completion of advance directives also but provide guidance to participants for discussing care preferences with their healthcare surrogate and healthcare providers. Plans for the 2018 National Healthcare Decisions Day include another Death Over Dinner event, as well as a reunion of individuals who have completed an advance directive and testimonials as to how ACP impacted medical care and interactions with healthcare providers.