Vol. 16, No. 8 - A Publication For Faculty, Staff and Friends of Wichita State University - December 2, 1999 

[Inside]

By Amy Geiszler-Jones

Using education materials and the personal touch seem to be the keys to getting people to sign documents guiding health care treatment, a WSU study has found.

When a group of 129 Wichitans were offered information and guidance about advanced directives in a six-month education program, 43 percent signed the documents. During that same time, only 8 percent of 90-member group who received no information signed advanced directives.

Advanced directives are documents such as a living will or durable power of attorney for health care decisions, particularly those made by loved ones at the end of one's life.

At seven Wichita-area congregations, Lou Medvene, associate professor of psychology, and a number of other volunteers implemented a program to educate people that such decisions should be made while one is well. As someone who has worked with self-help groups focused on care-giving issues for 15 years, Medvene sees the signing of advanced directives as a significant expression of showing one cares enough about their loved ones to relieve them of difficult choices.

What the researchers found was that getting people to see the benefits of such documents is "very labor intensive. It took a lot of people spending a lot of time talking with folks repeatedly on the phone or in person."

But the efforts paid off in an outstanding way. Similar programs done elsewhere in the United States generally have had a 25 percent success rate. Only about 15 percent of Americans have advanced directives, with many signed in hospital settings as a result of a 1990 health care bill that required hospitals to discuss directions with patients being admitted.

Discussing such an issue while a person is healthy is very different psychologically than when faced with an illness in a hospital, Medvene said.

One reason education programs are so "labor intensive" is "because you're working with a well population that don't feel a sense of urgency. They feel there's no need to do it today." Some also feel making such a decision is "tempting fate," he said.

Tapping into an existing group within a church, such as a Bible study group, was another key to the success rate. For example, one of the initial participating congregations was unable to recruit any participants.

"We tracked recruiting techniques, and they used the technique where they just put advertisements in the bulletin," Medvene said. "They didn't get any particular existing group to support the intervention. That's what we learned again and again is the key - to have a group within the congregation 'own' that program."

Other things discovered were: 

• Congregations tended to personalize the program, reflecting their culture. "It's important to allow people to do it in a way that fits," Medvene said. The high rate of signings or revisions was the same across denominations involved - Baptist, Catholic, Jewish, Lutheran and Methodist - and across cultures - African American, Caucasian and Hispanic.
  
• Expectations about how immediate family members would react were a significant motivating factor. "A lot of approaches that have been taken before and what the federal legislation assumed is that people's primary motivation is to get control of their medical care and decisions. The data we have says that's important, but what's more important is people feeling that it will benefit their family members.
  
• Parish nurses are the best qualified to act as advisers in such a program. "Some of the folks who worked with us last year were very enthusiastic, but they weren't comfortable in the role of advising people about health See Issues, page 8issues," Medvene said. "Parish nurses are much more comfortable because they do that professionally.

The program will continue this year, with the four churches that acted as last year's control group getting the education program.

Also, Alicia Huckstad, associate professor of nursing, and Medvene will continue to analyze data from the earlier participants about their motivation and decision-making processes. They'll look at such information as the health status of the participants or family members.

The program has been primarily funded by grants from the United Methodist Health Ministry Fund and the Via Christi Foundation.

Medvene will help implement a similar program with about 400 congregations in the Kansas City area during a spring sabbatical with the Midwest Bioethics Center in Kansas City, Mo.

Editor's note: A story about Medvene undertaking this project can be found in the Inside WSU archives online. The story, "WSU, 13 local congregations join in program," appeared Sept. 11, 1998. 

[Inside]