Advance health care planning is integral to our mission of improved care at the end of life.  It allows dying people to maintain their autonomy, families and friends to be certain of what their loved ones want and to advocate for it, and health care professionals to more compassionately provide the desired care.  It further encourages thoughtful discussion and decision-making outside the emotional pressure cooker of an immediate crisis.  The project's 23- member Advance Care Planning Task Force was created to achieve these goals.  This multi- disciplinary group represents key local organizations and professionals including:

• Both Missoula hospitals
• Home care agencies
• Hospice
• AARP
• Aging services
• Public health department
• Faith communities
• Clinics
• Long-term care facilities
• Emergency services
• Coalition for Montanans Concerned with Disabilities
• Doctors
• Nurses
• Physicians assistants
• Attorneys
• Social workers
• Chaplains
• Clergy
• Disabilities advocates
• Retirees, senior advocates
• Facility administrators
• EMTs

1. Accomplishments

In 1998, its first year, the Advance Care Planning Task Force achieved its initial goals, which LEI developed after reviewing preliminary results from our Community Profile research: to adopt a standard advance directive form and to conduct workshops for professionals.  In addition, the Advance Care Planning Task Force achieved another significant, but unstated goal.  The process of convening the task force brought people together from diverse backgrounds for the first time.  Members reported their discussions with their colleagues from other professions and organizations helped them better understand their own and others' roles in advance care planning, and forge meaningful relationships across discipline lines.

"My Choices"Advance Directive Form

While task force members recognized the importance of the advance care planning process, including the critical discussions that must take place, they chose first to focus on the advance directive as a structure for this process and a means of documenting it. They further felt the need to reduce confusion and bring consistency to the process of documenting people's preferences. Task force members wished to adopt a standard advance directive form to offer consistency throughout Missoula County, for use with adults of all ages, and for use in legal, health care, spiritual care, and other settings. With a common form, the advance directive concept and form could be introduced in one setting and completed in another. By using one form, professionals could more easily help people understand and complete the document. And finally, health care providers could become familiar with a consistent form and more quickly locate and understand the information it contains.

To adopt a standard advance directive form, a task force committee met nearly every week throughout the winter and spring of 1998.  After examining our community's needs from hospital, medical clinic, legal, spiritual, disabled advocacy, and consumer perspectives, this committee reviewed existing advance directive forms.  They decided to create a form and sought advice from the full task force as well as the Faith Communities Task Force; and LEI staff, board of directors, and international advisors.  The My Choices form is four pages written in plain English and conforms to Montana law.  It contains both power of attorney for health care and living will sections.  My Choices was adopted by Advance Care Planning Task Force member organizations after they pilot tested it throughout the fall of 1998 and the spring of 1999.  In addition, LEI developed an article, "My Choices: Creating an Advance Directive" to explain how to complete the My Choices form.  It was adapted with permission from an AARP publication.

Task force members have made presentations throughout the community about the My Choices form, the process that created it, and the value of using a common form.  In addition to speaking to key staff and departments within their own organizations, task force members targeted:

• Physicians with direct adult patient contact
• Ministerial association members
• Parish nurses
• Bar association members
• Senior housing complex managers
• Home health agency directors
• Long-term care facility administrators
• Retirement and financial planners
• Major health insurance group directors

Life's End Project

The Advance Care Planning Task Force also participated in the Life's End Project, a collaboration between the Life's End Institute and KUFM, Montana Public Radio.  KUFM received a Sound Partners for Community Health grant to work with us to identify end-of-life options, stimulate introspection and discussion, and to encourage end-of-life decision-making.  Task Force members and LEI staff met with program producers and artists to provide resources for 32 locally-produced radio programs. These programs were broadcast over a five-day period, reaching a potential audience of 300,000.  KUFM-FM news director Sally Mauk received a first place award in the Radio Enterprise category from the Montana Associated Press Broadcasters' Association.

With direction from the task force Education Committee, LEI also produced and distributed two publications.   We distributed an educational tabloid in the Missoulian newspaper reaching a potential audience of over half the county to raise awareness of advance care planning and its importance.  We also distributed brochures to every clinical setting in Missoula County encouraging people to talk to their physicians about advance directives.

The Life's End Project also brought Bernard Hammes, Ph.D., of Gundersen Lutheran Medical Foundation in LaCrosse, Wisconsin, to Missoula.  Dr. Hammes conducted two advance care planning workshops for professionals and gave a public lecture.  Medical, social worker, legal, pastoral care, hospice, and other professionals participated in the first workshop, "Why and How to Make Plans for End-of-Life Care."  LEI invited top professionals from medical records, information systems, and patient discharge departments to the second workshop, "How an Institution Records and Tracks Advance Directives."  In addition to the workshops, Dr. Hammes also gave a well-received public lecture on advance care planning, which drew a standing-room only crowd of all ages.

2. Missoula Choices Project: Action Plan

The Advance Care Planning Task Force has reviewed and revised the goals and objectives of the Missoula Choices Project.  This project will create a multi-faceted, community-based, community-wide advance health care planning system to empower adults during a most vulnerable time of life--its end.  This project will help adults who use legal, health-care and spiritual-care services in Missoula County maintain their autonomy.  It will also expand the capacity of professionals and institutions to support them in doing so.  LEI will build on its existing collaborative process to achieve the following objectives over the next two years: