Mary Washington Palliative, Hospice, and Grief Support Services

My mother and father recently planned a European cruise. They established a budget.  They determined the amount of time they wanted to travel. They created an itinerary and booked accommodations. They made certain their travel documents were in order.  For many weeks before the trip, they shared information about their travel plans with my siblings and me.   

My parents are very hesitant about discussing their end-of-life wishes.  My parents are not irresponsible.  They know how to plan.  Their planning can be exceedingly concise where while on vacation my sister, brother, and I know the day and hour my parents will eat pizza in Napoli.  What can we do to help create a culture where advance care planning is considered as necessary and beneficial as planning a vacation? 

Located in Fredericksburg, Virginia, Mary Washington Healthcare is a not-for-profit regional system dedicated to improving the health of the people in the communities we serve.  The Mary Washington Healthcare Ethics Committee has embraced an Advance Care Planning Campaign incorporating The Conversation Project resources. There is a general reluctance people have to thinking about death and dying.

We find an understanding of advance care planning can be instrumental in improving healthcare outcomes and alleviating this reluctance.  At Mary Washington Healthcare we:

Embrace National Healthcare Decisions Day (NHDD).  In recent years, we are increasingly seeing people who come to our hospitals specifically to learn more about Advance Directives.  We are looking forward to participating in NHDD activities this year.

  • We will promote NHDD in local media outlets and invite local media and the Community to the event. Learn more here.
  • We will have Associates who are comfortable walking people through the Advance Directive process at the event.  We hope to have some participants who leave the event with a legal, signed Advance Directive.
  • We will have a “mini-registration” for people who have never been patients in our system, so that we can scan their Advance Directives into our electronic record in case they do present in the future.
  • We will have displays, refreshments, both internal and external speakers, participation by LifeNet and The Conversation Project. 
  • We will provide Advance Directives, both a long and a shorter, simpler version in English and Spanish. 

Inform Providers. It is common for healthcare providers to wait for the patient to begin the conversation about advance care planning.  We encourage providers to take the lead in initiating a conversation about advance care planning. 

  • We created a Palliative and Hospice Care Physician Resource Guide. The Guide highlights advance care planning resources. The Guide includes an Advance Care Planning Billing Guide.  
  • We have recorded an advance care planning podcast which we share with physicians. Click here to access the recording.

Identify Opportunities.  Seek organizations who are committed to improving healthcare outcomes and ask to partner. 

  • We utilized the opportunity to feature the documentary, Being Mortal. The opportunity was coordinated by the Hospice Foundation of America from funds provided by the John and Wauna Harman Foundation.  We partnered with our local library system to screen the documentary at our regional libraries.  Each screening was followed by a post-documentary panel discussion.  
  • We partnered with AARP Virginia’s Movies for Grown Ups.  We screened the movie The Theory of Everything.  The screening was followed by a panel discussion on advance care planning and caregiving. 
  • Every year, we partner with the Spotsylvania, Stafford, Fredericksburg TRIAD and present advance care planning information at their end of life series.   (The TRIAD is a Cooperative Agreement between AARP, International Association of Chiefs of Police, and the National Sheriffs’ Association.  Their mission is to protect our growing elderly population. Click here to learn more.)

Provide Tools.   Provide copies of Advance Medical Directives, The Five Wishes, and The Conversation Project Starter Guides.  Utilize every opportunity to present and provide these resources.

  • We have found most people are not ready to complete an advance directive immediately after we present advance care planning material. We are establishing advance care planning office hours where people can ask questions about advance care planning, including receiving assistance to complete an advance medical directive.  

Ask for Advice.  Seek local leaders who may be able to help with public engagement campaigns and provide networking opportunities.

  • Our local Chamber of Commerce Leadership Fredericksburg Program selected Mary Washington Healthcare’s The Conversation Project in the Fredericksburg Region initiative as a project.  Leadership Fredericksburg examined creative ways to create a multi-faceted marketing strategy to promote advance care planning awareness in our region and provided feedback to our team about funding opportunities (click here to learn more).

Meaningful and lasting change takes time.  We continue to educate and encourage staff, patients, and families to get their thoughts together, talk to their providers and loved ones, and document their wishes.  I continue to embolden my parents to discuss their end-of-life wishes with my sister, brother and me. Perhaps my parents will be more motivated to advance care plan if they are enticed with a vacation. Mom and Dad, can we cruise?

Terri McAuliff is the Community Liaison with Mary Washington Palliative, Hospice, and Grief Support Services.   

To learn more about Mary Washington Healthcare’s efforts contact Terri McAuliff or Ashland Evans, MHA, CHPCA Director, Palliative, Hospice, and Grief Support Services.