Fellow Bio:
Katie comes from Brodhead, WI and graduated from the University of South Carolina. Through varied volunteer activities, she has become interested in working with the elderly who live with their families. Katie would like to take a leadership role in developing programs to improve adult day care, family counseling, and financial assistance in order to improve family relationships.

My project is an attempt to look at the communication taking place between physicians and their patients concerning advanced planning and end-of-life planning. Advance directives are a means of formalizing the process of advance care planning. Many studies have already looked at the barriers to the completion of advance directives. I am proposing that in a strong doctor-patient relationship, with a continuum of communication about the patient's beliefs, values, and long-term goals, doctors have a good understanding as to the end-of-life wishes of their patients.

I plan to test this by selecting doctor-patient dyads from around the area and conducting interviews to determine the current level of communication. I will develop medical scenarios and ask both the doctor and the patient to answer questions about the appropriate level of treatment for each scenario. The doctors will be answering on behalf of their patients and the patients for themselves. I will then compare the answers and determine whether the congruence between the answers mirrors how well the doctors feel they knew their patients. Hopefully, I will see some close matches and be able to determine what methods worked well for those doctors and patients.

This project would initially collect data as to the number of people of Green County that have completed the proper documents for Living Wills, the establishment of Durable Power of Attorney, and "Do Not Resuscitate" directives when needed. There would be some identification as to the reasons and/or obstacles for not having the documents done including sensitivity for cultural differences related to the subject, especially as this relates to the growing Latino population in Green County.

The second part of the project would include using the gathered data to tailor a program of education to inform people of the use, benefits, and limitations of such paperwork. There will be collaboration in this effort between the Health Department, The Monroe Clinic Homecare\Hospice, and all Green County medical providers. The eventual goal is to integrate the public education program with a family advocacy project modeled after similar programs currently employed in New England.

Project Objectives:

1) To gather statistical information as to the use of Living Wills, Durable Power of Attorney, and "Do Not Resuscitate" documents by the people of Green County.

2) Determine the effectiveness of these documents and identify barriers to their use.

3) Assess cultural differences in death and dying.

4) Use local physicians, emergency room personnel, hospice personnel and emergency medical services personnel to educate the citizens of Green County about end of life documents.

5) Continue the education of medical professionals to present a unified response to end-of-life planning.

6) Lay the groundwork for implementation of a legal advocacy program to promote better access to legal documents, advice, and advocacy for the elderly and Latino population.

My hope is that this project will give us the necessary information concerning barriers to end-of-life planning so as to better educate the public to promote confidence that their autonomy in end-of-life will be maintained.

Through education we will paint an accurate picture and raise awareness as to the value in having such documentation in place. This will facilitate patient choice and promote autonomy at a time when these rights are threatened. It will also increase understanding and improve the collaborative efforts among local health care providers and patients.

On a more personal note, I anticipate that this project will further my education into the sensitive issues surrounding end-of-life planning. I believe that this project will have a positive affect on the local community and potentially on my medical school class as they pursue their careers in medicine and are faced with end of life issues in their practices. The program should also leave a lasting impact on the medical providers and citizens of Green County in being able to address and carry out end of life directives

I anticipate that my main challenge will be in dealing with peoples' uneasiness concerning such a delicate topic as end-of-life planning. It is necessary when developing my approach to information gathering, to take this into consideration. I have read a great deal of literature on this topic and plan to emulate past methods and interview styles.

Another challenge I may face is acquiring active participation from the community and health caregivers. I plan to again consult past successful approaches.

I realize there are many other potential challenges with this project and hope that as each arises I will be prepared due to my past research in this area, support of my mentor, as well as support from the Green county Department of Public Health.

One of the reasons for my change in topic relates to my not getting the grant that I had applied for through SWAHEC. Because, I am working on a much smaller budget I have decided to stay closer to home and focus my topic on the communication aspect of advance planning. My previous project idea was a bit too broad, and I feel like my new focus is something that I can really wrap my mind around and hopefully be able to accomplish. Other challenges include IRB approval, funding, time issues, manuscript submission and acceptance.

(March 2002) Since my last report, I have altered my project goals and overview. I had previously been hoping to conduct qualitative research in Green County about advance directives. I have now changed my focus from advance directives to a more general, and useful, topic of communication between physicians and patients and how this lends to successful advance care planning.

(Nov 2004) The manuscript for our research has been accepted for publication in the American Journal of Hospice and Palliative Medicine.

Thanks to the wonderful support of Dr Marchand our project has been successful and we have learned a great deal about advance directive use within the community as well as coalition development. I was able to speak to many influential individuals through the process of key informant interviewing and have personally grown as an interviewer and really learned a lot about the topic.

Resource Needs:

I will have office resources through Green County Dept. of Public Health. I will need living expenses and gas money. I may require additional money to publicize the study and recruit community resources (such as renting meeting rooms, providing coffee and snacks for participants, etc...). I have my own transportation. I may eventually need the help of a statistician for generating accurate meaningful results and conclusions. I have already inquired, via summer opp. fair, if other medical students would be interested in helping with information gathering, they are. (However, I am a little hesitant to pursue this, due to the limitations of student interviewers seen in past research studies). I will need money to pay for the phone bill I will inevitably generate due to the fact that Monroe is a long-distance call.

Last update:

Nov 30, 2004

A indicates the item has been completed.

Completed	When	What	On-line
	Year 1: Beginning of Semester 2	New Project Report	Submit Report
	Year 2: Beginning of Semester 1	Project Update	Submit Update
	Year 2: Beginning of Semester 2	Project Update	Submit Update
	Year 3: Beginning of third year	Project Update	Submit Update
	Year 4: August of fourth year	2-3 page final summary of project that includes a reflective evaluation of the project process	N/A
	Ongoing	Participate in program evaluation (written and/or focus group)	View Options
	By the end of fourth year	Select poster, presentation, paper, creative option or your own idea	View Options

Comments? Feedback? webmaster@fammed.wisc.edu
© 2003 University of Wisconsin-Madison Department of Family Medicine