Advance Care Planning for Hospital Staff

The Problem:
Estimates indicate that less than 30% of the population has an advance directive, such as a healthcare power of attorney or living will, which guides decisions about healthcare if a person is unable to make their wishes known.

The Goal:
AnMed Health Chaplaincy Program wanted to innovate their role in end-of-life conversations by training chaplains and engaging them more broadly with patients beyond palliative care.

Method & Implementation:
The Pastoral Care Program at MUSC began taking part in National Healthcare Decisions Day in 2007 by setting up information tables in every hospital building for both the day and night shifts to learn more about advance care planning. The Palliative Care Program joined in this event once it was formed three years ago. The event focuses on beginning the conversation with loved ones and teaching staff how important it is for everyone—not just the elderly—to talk with their loved ones about their wishes. Each table has blank healthcare power of attorney documents and information about The Conversation Project starter kit that can provide additional guidance.

As a medical university as well, MUSC has also engaged their students in advanced care planning. Through the Senior Mentor Program, each medical school student is assigned a senior citizen in the community and follows them over the course of their four years with different medical tasks. By providing these students with a long-term patient contact experience with senior citizens, the goal is to improve their knowledge of aging, and positively affect their attitudes towards caring for older adults. In their last year, students are required to do an advance directive with their senior mentor, providing valuable experience on how to have these important conversations.

Results:
While the process of increasing awareness and promoting advanced care planning outside of the patient population is difficult to track, Mary Catherine Dubois, a Palliative Care Social Worker at MUSC who spearheads this work, says that she can see a clear difference in how advance care planning is thought of in her hospital system. “I’ve seen a change among staff in recognizing that it isn’t just for older patients, that it’s also for [them],” she points out.

“[And] a lot of the medical students had extreme anxiety about bringing up this conversation with an older person. They thought it was rude, they thought it was somehow letting the patient know they thought something was wrong with them, instead of it being a normal thing that we need to talk about.”

Thanks to their efforts, advanced care planning is now more embedded in the culture of their hospital system.

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