Advanced Directives 2023
| Responder | Stephanie Batch |
| Project Title | Advanced Directives 2023 |
| Start Date | 8/18/22 |
| End Date | 3/31/23 |
| Project Location: City | San Antonio |
| Project Location: County | Bexar |
| Other Student Leaders | Stephanie Batch, Medical Ricardo Verdin, Medical Ryan Bailey, Medical Hildemarie Wiggill, Speech Language Pathology |
| Community Partner Organization | Caring for the Caregiver |
| CSL Mentor – Name | Jason Morrow |
| Other Mentors | Sara Masoud, PhD(c), MPH |
| Is this project interprofessional? | Yes |
| Professions Represented | Medicine,Nursing,Speech Language Pathology |
| Project Category | Education |
| Project Activities | Focus Groups/Surveys/Interviews,Health Education |
| Is this project conducted as part of a student organization? | Yes |
| Student Organization Name | Geri-Pals (Geriatric Palliative Care Student Interest Group) |
| Is this project done as part of an academic course (required OR elective)? | Yes |
| Course Name | Leadership in CSL Enrichment Elective – ELEC 5044 |
| Community Partner Name | Sara Masoud |
| Community Partner Job Title | Caring for the Caregiver Program Manager |
| Total Number of Students on Project Team | 8 |
| Number of Community Beneficiaries | 95 |
| Total Number of Other Faculty/Staff | |
| Number of Other Community Volunteers | |
| Mentor Hours | 2 |
| Student Leader Hours | 50 |
| Total Number of Student Hours | 1000 |
| Semester Service Hours | 500 |
| What type of funding did you use to conduct this project? | CSL Mini or Midi grant from the Center for Medical Humanities & Ethics |
| Mini/Midi Grant Amount Awarded | $2,427 |
| Did you do this project as part of Federal Work Study from the Office for Financial Aid? | No |
| Did you receive In-Kind Donations for this project? | No |
| Amount of In-Kind Donation $ | N/A |
| CSL Abstract | CSL 2023 Abstract.pdf |
| CSL Poster | CSL 2023 Poster – Advanced Directives 2023.pdf |
| Challenges | Our big challenge was building a network of connections of places that we could present. We said we were aiming for 150 people, which was an ambitious number, so finding places where our target audiences (older adults) congregate and might be willing to talk about death was challenging. Many people at nursing homes, senior living places, and some senior centers hung up on us very quickly, due to our group not having a pre-established rapport. Our time frame was also November to January, and people particularly did not prefer us talking about death around the holidays. Furthermore, due to the high Spanish-speaking population in San Antonio, we had to adapt our presentation materials to Spanish, as well as English. We adapted a traditional paper survey format and simple/large presentation text since our audience was an older demographic. The use of language was also considered, such as using “wishes†as the preferred term when discussing end of life choices. This challenge wasn’t as big of an issue, since we had a Spanish-speaking individual on our team, but it’s important to keep language barrier and other community-specific communication considerations in mind, especially in a high-Spanish speaking community like San Antonio. |
| Lessons Learned | Finding connections through people who already had connections at our community organization, at places that we’d already done presentations, and through community health workers at the Center for Medical Humanities and Ethics was helpful. Overall, it was interesting to get practice talking about advanced directives and seeing what people said about their experiences with death and with the medical community at the end of life. There was a lot of guilt. People generally had fulfilling experiences with hospice or death doulas, if they communicated well. In the end, we feel our whole CSL group feels more comfortable talking with people about the end of life thanks to this endeavor, which will help us in our professional career. Going forward, it’s important to keep in mind that when creating connections with community partners, one shouldn’t underestimate the amount of work and effort that goes into networking, recruitment, and program development. Give a project plenty of preparation time so you may create quality connections with different support groups, and don’t be discouraged if plans fall through or attendance isn’t what you expect. Above all else, have fun with it! You get to meet so many interesting people this way and get to hear their personal narratives and learn from them. |
| Success Story | Senior centers tended to have good turnouts, with a wide variety of initial perspectives and knowledge of advanced directives and hospice. High audience engagement in the form of Q&A and story sharing about individuals’ own advance care planning experiences had really enhanced the sessions. People in the community want to talk about advanced care planning and they do have questions, they are just looking for an outlet to discuss these topics outside of the occasional 15 minute clinic visit. One particular talk we had at St. Timothy’s Church ended up with ~30 attendees just at one session, with a high amount of audience questions and personal experience sharing. Above giving the technicalities of advance directives and definitions what is included in the legal form (life sustaining measures, medical power of attorney, etc.), the audience at each session really made the talk theirs, in relating specific measures to what happened in their life or to their loved ones that helped contextualize the discussion beyond the objective medical jargon. In general, we tended to come away from each class with more new questions that people asked that we hadn’t thought about before or more hard situations that we hadn’t considered. There were a lot of questions about the legalities of DNRs and whether having a wallet card or posting it on your fridge would help it be respected, even though EMTs and people in the hospital said that often they’d start doing CPR before realizing a person had a DNR. There were stories where a dying person kept asking for coffee even though they couldn’t swallow, and after someone gave them coffee, the person died, making the helpful person feel responsible for the death. One attendee was a medical power of attorney for her husband who had dementia. He wanted everything done at the end of life, but she wanted to make him a DNR, which seemed like a complicated situation. The best examples were where people didn’t know what advanced directives were, but after we talked about why they were important for reducing the burden on families at the end of life, they got excited about getting one. The security guard at the library we presented at even remarked, “Why doesn’t everyone have one of these?! I have to go home and make an advanced directive for my parents and I.” |
| Conferences Where You Presented Project | Perhach A, Batch S, Bailey R, Verdin, Prasad S, Wiggill H, Kuhn A, Morrow J, MD. Advance Directives 2023. Poster presented at: Texas and New Mexico Hospice Organization; February 25th, 2023; Irving, TX. |
| Publications of your Project | N/A |