Advance Health Care Planning for Self-Described Healthy Senior Adults in a Church Community,a Pilot Project: Educational Methods and Outcomes

Dear Editor:

Advance care planning (ACP) is described as a process that supports adults of any age or stage of health in understanding and sharing their personal values, life goals, and preferences regarding future medical care. ¹ Despite improved quality of care with ACP, few American adults have end-of-life conversations and only a third formalize these decisions into advance directives. ²

The landmark 2014 Institute of Medicine report, “Dying in America” calls for more proactive ACP encompassing appropriate educational methods, evidence-based information, selection of target audiences with involvement of family members, meaningful participant dialogue, and encouragement of faith-based organizations to support ACP based on needs and values of their congregants. ³

St Michaels and All Angels is a large Episcopalian church with highly educated parishioners in the metropolitan Kansas City area. We recruited parishioners for a three-part ACP educational project focusing on the following questions:

“What kind of medical care do you want, that is right for you, if you have a serious illness?”

“Who knows what you want and can speak for you (honor and respect your wishes) if you cannot?”

Learning objectives included understanding (1) common patient care interventions; CPR, endotracheal intubation, and mechanical ventilation; (2) goals of care; for example, life-prolonging care, limited care, and comfort care (palliative care, hospice care); (3) health care directives; and (4) expressing individual wishes through conversations/letter writing.

Curriculum content included five patient education videos developed by Advance Care Planning Decisions, https://acpdecisions.org, with titles of Goals of Care, Mechanical Ventilation, CPR, Healthcare Directives, Hospice/Palliative Care, as well as websites of The Conversation Project, https://theconversationproject.org, and the Stanford Medical Letter project https://med.stanford.edu/letter.html

Project structure included (1) precourse work of ACP knowledge survey completion, video, and website review; (2) course attendance at an hour-long educational content review and discussion; and (3) postcourse work of repeat survey completion and ACP discussion with family.

Two groups of congregants were studied: a first group of 14 senior individuals and a second group of 18 seniors with 7 husband–wife pairs.

Surveys queried participant knowledge and understanding of goals of care, common patient interventions, palliative/hospice care, and health care directives. Precourse results indicated most participants (50–75%) claimed specific knowledge about aspects of ACP; however, after course completion, survey data described 100% of participants with knowledge and understanding in each of these areas. Almost 70% (25/36) reported planning and or completing ACP family conversations.

Our pilot project in a highly educated group of Episcopal parishioners demonstrated improved advance care learning after a focused educational process utilizing precourse work of diverse proven media educational methods, ⁴ detailed group discussion involving family members and outcomes expectations of family care conversations.

We recognize the preliminary aspect of this work and the need for future work to explore outcomes in similar groups of self-described healthy, elderly parishioners. We believe our work is important as it focuses on a population of church community not previously described, targets a nonhospital nonambulatory clinic setting, and utilizes proven mixed educational methods, including pre- and postcourse work.