Set Long-Term Care Planning in Motion
Advance care planning is one of those topics that tend to get postponed until there is a crisis, when the planning is no longer “in advance” but “right now.” It’s difficult enough to do without placing all the emphasis on a single momentous conversation. A study by Terri Fried and colleagues at Yale University School of Medicine found that many people go through six stages of change on the path to actually taking action to complete an advance directive and name a health care proxy. These stages are precontemplation (“I’ve never thought about it”) to contemplation, preparation, action, and maintenance (reviewing plans).
Using this framework, Rebecca Sudore and colleagues at the San Francisco VA and University of California, San Francisco, Division of Geriatrics, developed a website called PREPARE to guide older adults and their families through these stages.
The tool guides users through the process of choosing a decision maker (a health care proxy), deciding what matters most in life, choosing flexibility for your decision maker, telling others about your wishes, asking doctors the right questions, and making a plan.
The type is large and each screen has one idea. Each stage of the process includes videos and stories about how individuals have made different choices. You can stop the process at any stage, save the information, and come back to it at a later date. Unlike some other tools, PREPARE starts with selecting a decision maker, which is a critical step, and may make it easier to go on to the next steps. It also includes giving the decision maker flexibility (or withholding that option), which is also seldom part of the process.
Early testing of PREPARE found that it improved the ability of users to move from precontemplation to contemplation and along the scale toward action. And even those who are not regular computer users found it very easy to use.