Right to Make Decisions about EOL Care

1. End-of-Life Care Challenge from the California HealthCare Foundation: Catalyzing Communication about End-of-Life Care • CACCC Multi-pronged Minority mHealth Solution Right to Make Decisions about EOL Care

2. Why Plan Ahead? Advance Care Planning Cycle • 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 Advance Care Planning Good communication and education about end of life is an essential part of healthy aging (Neimeyer, Wittkowski, Moser, 2004).

3. Problems with Advance Care Planning • Why only one-third of adults have prepared an advance directive? • System factors • Cultural differences • Personal factors • Confusion and myths http://www.cdc.gov/aging/pdf/advanced-care-planning-critical-issue-brief.pdf http://coalitionccc.org/documents/FinalChapterDeathDying.pdf

4. Targeted Audience Secondary Audience Who will Influence/Assist the Completion of Advance Directives? Providers Family members Caregivers Health educator/navigator Volunteers/advocates Advance care planning experts e.g. insurance agents Primary Audience Who will Complete Advance Directives? Anyone 18 and above….. Special Considerations Cultural and linguistic needs 2. Literacy level variation 3. Chronic illness patients 4. Mentally challenged, disability and special needs 5. Technology and learning needs

5. Multi-pronged Solutions and Interventions Active Approach Effective but could be Costly and Time Comsuming Provider’s initiation Trained volunteer/assistants WorkshopsIndividual counseling: social workers, health educator, advance care planning experts Support group/network Passive Approach Culturally, Linguistically, Literacy-Level Appropriate Materials Patient, caregiver, and provider education level Website Mobile application Traditional media: TV and Radio Social media: Facebook, Twitter, Podcast, YouTube Support hotline for patients and providers Systematic review (Tamayo-Velazquez, 2010) of AD promotional interventions: Most effective : The combination of informative material, provider initiation, repeated counseling and update Advocacy Partnership Resource Mobilization Research Intervention  TrainingPolicy

6. Pilot Project Targeted Population Chinese-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.

7. Pilot Project Targeted Population Smartphone 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

8. Expand the use of existing service and documents New Age Solution: Mobile Health (mHealth) 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 English/Chinese Glossary developed by CACCC

9. Key functionalities/advantages New Age Solution: Mobile Health (mHealth) • 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

10. New Age Solution: Mobile Health (mHealth) Step-by-Step Interactive Approach Incorporate Campaign and/or Education Material to Increase Engagement Bilingual Support Click-To-Call Hotline Text-To-Speech Mobile Forum for Resource and Encourage Discussion

11. Possible Future Directions New Age Solution: Mobile Health (mHealth) Online/Mobile Continued Medical Education Research project: Partner with academic institute Other language versions: Partner with other community based organizations Culturally Appropriate Regional EOL Resource Guides

12. CACCC Multi-pronged Minority mHealth Solutions Conclusion • 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.

13. Right to Make Decisions about EOL Care • Acknowledgement Mr. Samuel Sung