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University of Wisconsin, Madison, WI EXECUTIVE SUMMARY: The high readability level of our state’s Durable Power of Attorney for Health Care (POA-HC) form limits patient understanding and successful completion of the document. In complex medical situations where patients are not able to speak for themselves, lack of a completed POA-HC form results in significant delays in decision-making, undue family stress, and costly legal interventions. The overall goal of this project is to design a legally acceptable, low-literacy Power of Attorney for Health Care alternative and successfully implement its use across all inpatient and outpatient settings within our organization. Additionally, we aim to increase the number of completed forms, particularly for those individuals that can anticipate circumstances in which the POA-HC may need to be activated. Improvements that will be measured include:
PROJECT PLAN: Step 2: Prepare and submit program for Internal Review/Humans Subjects Committee review. Step 3: Draft low literacy POA-HC instructions written at a 5th to 6th grade level. The Patient Education Manager will draft the initial language. Key clinicians including social workers, nurses, and physicians, and an attorney will be consulted to ensure the instructions are easy-to-understand, accurate, and legally sound. Step 4: Design a form that wraps these instructions around the state’s existing Power of Attorney for Health Care form using an “overlay” design. Certain areas of the overlay would have “cut outs” to allow patients to print necessary information directly onto the legally accepted form. The Patient Education Manager and interested project team members will work with the organization’s print shop. If they do not have the capability to design and print such a form, an external print shop will be consulted. Step 5: Finalize design of evaluation plan. The project team in consultation with our Nurse Research Specialist will finalize patient consents and evaluation survey tools to use during the pilot. Step 6: Pilot the form with overlays in select clinics where there is a high need for clear advance medical directive planning (e.g., Oncology, HIV-AIDS, Transplant, Geriatrics and Family Medicine). The Patient Education Manager and at least one Social Worker will meet with the staffs of each clinic to explain the project and gain support for its implementation and evaluation in their clinical environment. A physician at each site will serve as a “champion” for the project. While the needs at such clinics as Oncology, Transplant and Geriatrics are obvious; it is interesting to note that the Family Medicine Clinics offer us unique demographics. At one of the Family Medicine Clinics, 55.4% of the patients seen are ages 40-89 years of age. At a second site, only 47.2% of individuals are 40-80 years old; however, this clinic is seeing a growing number of Afro-American and Hispanic patients. Step 7: Conduct the evaluation during the pilot. The staffs of each clinic will be responsible for consenting patients and gathering evaluation information. The tools will be designed so as to not further complicate the POA-HC completion process. Step 8: Revise the form overlay and implementation process based on pilot and evaluation feedback. The project team members will compile the results of the verbal and written survey instruments and adapt the tools and/or implementation accordingly. |
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Alexandria, VA 22314-3403
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