A community-based workshop led by nurses is inspiring people to make end-of-life plans with loved ones.

"There are a lot of people who still have misunderstandings about the need for advanced directives so we felt it was important to offer this workshop to the community before they or their family members or loved ones get sick," Katherine Hinderer, PhD, RN, from Salisbury University, in Maryland, told Medscape Medical News.

"Almost all of them indicated that the workshop increased their understanding of advanced directives," she said.

Older people were much more likely to prepare such a plan, Dr. Hinderer added. "I guess those of us who are young are often resistant to talk about these issues."

The work, presented at the American Association of Critical-Care Nurses 2013 National Teaching Institute and Critical Care Exposition, in Boston, Massachusetts, included 81 people.

Dr. Hinderer and research student Patty Rubin, RN, also at Salisbury University at the time, developed, implemented, and explored whether or not a community-based workshop would encourage more planning.

In critical care settings across America, patients are so ill that they are not able to make their own decisions.

"I also invited members from interdisciplinary teams to offer presentations on some of the legal and medical terms that are on an advanced directive form because these terms can be very challenging to understand," Dr. Hinderer explained.

For example, people do not necessarily know what "life-sustaining therapy" means. Nor do they really understand "withdrawal of support." Yet both of these terms are on the advanced directive form they must complete.

After the workshop, Dr Hinderer asked people to complete a survey about the likelihood that they would complete an advanced directive themselves or whether they would talk about an advanced directive with loved ones. The survey response rate was 86%.

More than 91% of participants who completed the survey said they would complete a plan and talk to a loved one about it.

"One of the important things about advanced directives is the communication piece," Dr. Hinderer said. It's not just filling out the form, she explained, but talking to family members and loved ones about what they themselves would want to happen in an end-of-life situation when they are not able to talk for themselves.

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"Our society is so death-denying," she added. "Yet in my experience, a lot of older adults are very happy to talk about death. So I think with some simple planning and connecting with key stakeholders in advanced care planning, it is relatively easy to plan a workshop in the community and give people a chance to share stories about how families suffer when they have to make decisions for their loved ones when they really don't know what the loved one wants."

Asked by Medscape Medical News to comment on this work, Debra Wiegand, PhD, RN, from the University of Maryland School of Nursing, in Baltimore, said she felt that Dr. Hinderer's work is extremely important because only 20% to 25% of Americans have advanced directives.

"In critical care settings across America, the majority of patients are so ill that they are not able to make their own decisions," she explained. "So, the health care team turns to each patient's surrogate to make decisions on each patient's behalf and most families haven't had these important end-of-life discussions."

Dr. Wiegand said, "These discussions are so important because nurses and physicians are able to honor patient wishes and help families as these decisions are made."

Dr. Hinderer and Dr. Wiegand have disclosed no relevant financial relationships.

American Association of Critical-Care Nurses (AACN) 2013 National Teaching Institute and Critical Care Exposition: Abstract C30M272. Presented May 22, 2013.


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