Transformation of the advance care planning process through the use of an online computer-assisted instruction program and electronic health record enhancements at the University of Missouri

The Institute of Medicine report (1997) defines a good death as “good care at the end of life…depend[ant] on strong interpersonal skills, clinical knowledge, and technical proficiency, and it is informed by scientific evidence, values, and personal and professional experience” [1]. With only one-third of Americans having an
advance directive [2], the failure to identify, choose, and define personal health preferences in end-of-life care has largely prevented the United States healthcare system from providing “good deaths” to many. The central hypothesis of this study is that through the development and deployment of a novel and meaningful tool, users will have the opportunity to develop and modify over time an advance directive (AD) unique to them which informs the medical community, caregivers, and their family members of their choices and preferences for their end-of-life health care decisions. This ongoing study aims to 1) transform the manner in which ADs and healthcare proxy documents are created by patients 2) improve document retrieval by healthcare providers within and outside of the health system and 3) embed a data infrastructure within the EHR to support future mining and analysis of population adoption, preferences, and outcomes.