Right to Make Decisions about EOL Care

End-of-Life Care Challenge from the California HealthCare Foundation:

Catalyzing Communication about End-of-Life Care

CACCC Multi-pronged Minority mHealth Solution

Advance Care Planning Cycle

2

Why Plan Ahead?

Patients are able to speak for themselves

Peace of mind for loved ones

Improve EOL care and QOL

Avoid unnecessary suffering, confusion and conflicts

Learning and empowerment

Good communication and education about end of life is an essential part of healthy aging (Neimeyer, Wittkowski, Moser, 2004).

Learn & Get Update

•About your EOL options

Think & Rethink• About your

values & preferences

Talk•About your

decisions

Document•About your

wishes

Advance Care

Planning

Problems with Advance Care Planning

3

System factors

Cultural differences

Personal factors

Confusion and myths

http://www.cdc.gov/aging/pdf/advanced-care-planning-critical-issue-brief.pdfhttp://coalitionccc.org/documents/FinalChapterDeathDying.pdf

Why only one-third of adults have prepared an advance directive?

Targeted AudienceSecondary AudienceWho will Influence/Assist the Completion of Advance Directives?

1. Providers2. Family members3. Caregivers4. Health

educator/navigator5. Volunteers/advocates6. Advance care planning

experts e.g. insurance agents

Primary AudienceWho will Complete Advance Directives?

Anyone 18 and above…..Special Considerations1. Cultural and linguistic

needs2. 2. Literacy level variation3. Chronic illness patients4. Mentally challenged, disability and special needs5. Technology and learning needs

Multi-pronged Solutions and Interventions

5

Active ApproachEffective but could be Costly and Time Comsuming1. Provider’s initiation2. Trained volunteer/assistants3. Workshops Individual

counseling: social workers, health educator, advance care planning experts

4. Support group/network

Passive ApproachCulturally, Linguistically, Literacy-Level Appropriate Materials1. Patient, caregiver, and

provider education level2. Website3. Mobile application4. Traditional media: TV and

Radio5. Social media: Facebook,

Twitter, Podcast, YouTube6. Support hotline for

patients and providers

Advocacy Partnership Resource Mobilization Research Intervention Training Policy

Systematic review (Tamayo-Velazquez, 2010) of AD promotional interventions:

Most effective : The combination of informative material, provider initiation, repeated

counseling and update

Pilot Project Targeted PopulationChinese-American in California

California nation's largest Asian-American population

Between 2000 and 2010, the Asian American population of California grew 34 percent.

Chinese born immigrants represented the second-largest immigrant group (after the foreign born from Mexico), and accounted for 4.5 percent of the total foreign-born population.

Culturally and linguistically appropriate resources are limited for Asian and Chinese-American populations.

Pilot Project Targeted PopulationSmartphone Penetration (Sources: Nielsen Report and Pew)

Hispanics, Asians are most-likely Smartphone owners in the U.S.

US has reached 55% smartphone penetration for the age of 18 and above.

Seven in ten seniors own a cell phone, up from 57% in 2011

Low income discounted mobile service available in California

California low income discounted mobile service

http://www.nielsen.com/content/dam/corporate/us/en/microsites/publicaffairs/StateoftheAsianAmericanConsumerReport.pdf

Patients

Family / Caregivers

Other audience

Providers

New Age Solution: Mobile Health (mHealth)

8

English/Chinese Glossary developed by CACCC

Chinese POLST & Easy AD Form Translated & Modified by CACCC

English-Chinese EOL Materials & Video developed by CACCC

Exiting Bilingual Line Support by CACCC

Onsite AD Workshops

Expand the use of existing service and documents

New Age Solution: Mobile Health (mHealth)

9

Pilot project targeted to one of the fastest growing underserved minority populations

Large scale nationwide mHealth EOL education and support services Provide handy resources, tips, updates, support and referrals Mobile interface design (easy icon) for low-literacy and senior populations Linguistically and culturally tailored materials Interactive sessions and media for effective learning Online social network/support opportunities, email updates Increase accessibility of EOL care planning and services Create valuable partnership opportunities mHealth provides a cost-effective solution supplementing interpersonal

outreach and intervention

Key functionalities/advantages

New Age Solution: Mobile Health (mHealth)

10

Incorporate Campaign and/or Education Material to Increase

Engagement

Step-by-Step Interactive Approach

Bilingual Support Click-To-Call Hotline

Text-To-Speech

Mobile Forum for Resource and Encourage Discussion

Patients

Family / Caregivers

Other audience

Providers

New Age Solution: Mobile Health (mHealth)

11

Culturally Appropriate Regional EOL Resource Guides

Online/Mobile Continued Medical Education

Research project:Partner with academic institute

Other language versions: Partner with other community

based organizations

Possible Future Directions

Conclusion

12

Advance care planning and education is a process, not a single event.

The problems with and barriers to advance care planning are multi-faceted.

Multi-pronged strategies are necessary to outreach various target audiences.

mHealth has been proven to be effective in the field of health behavior change.

mHealth can reach out to the fastest growing mobile users, multi-level population.

mHealth provides a cost-effective solution, supplementing interpersonal outreach and intervention.

CACCC Multi-pronged Minority mHealth Solutions

Right to Make Decisions about EOL Care

Acknowledgement

Mr. Samuel Sung