Design Challenge: Catalyzing Communication About End-of-Life Care


In a 2012 study of Californians’ attitudes and experiences with death and dying, 60% of respondents said that making sure their family is not burdened by tough decisions about their care at the end of life is “extremely important.” Yet 56% had not communicated their end-of-life wishes to the loved one they would want making decisions on their behalf, and only 23% said they had their wishes in writing.

Many tools have been designed to guide people through having the conversation about their wishes and completing relevant forms, yet few people act on these opportunities.

To motivate action, CHCF partnered with Mad*Pow, a user-centered design studio, to present a design challenge aimed at getting more people to complete advance directives early, revisit them periodically, and for people with serious illnesses, to document their end-of-life wishes.

  • ADVANCE CARE PLANNING ON FACEBOOK. A Facebook application that allows people to complete an advance directive; invite family and friends to access it and become health care proxies; and create an advance care planning network to encourage others to complete their own advance directive. <a href="/resources/download.aspx?id=3C38DD1F-3891-4870-B129-BC6987BFD644" target="_blank" style="color: #FFF; font-weight: bold;">View Entry</a>
  • GIFT OF GRACE. A set of cards, given to loved ones, that feature questions, activities, and phrases to help people comprehend the complex issues involved in end-of-life care and determine their own specific preferences for that care. <a href="http://actionmill.com/grace" target="_blank" style="color: #FFF; font-weight: bold;">View Entry</a>
  • VIEW FROM THE BED. A photography project and information campaign to tell the story of critical illness through images of family gathered around the bedside. Seeing the exhaustion, hope, commitment, fear, and love on these faces might motivate people to complete an advance directive. <a href="http://www.youtube.com/watch?v=izDwwX_CnM8&feature=youtu.be" target="_blank" style="color: #FFF; font-weight: bold;">View Entry</a>
  • VIMTY. An intuitive web tool that lets individuals document, store, update, and share their end-of-life wishes with health care providers, assigned health care agents, and family members. <a href="http://vimty.dtailstudio.com/" target="_blank" style="color: #FFF; font-weight: bold;">View Entry</a>
  • WISH PAPERS. A campaign to demystify advance directives and to leverage existing touch points to encourage their completion. For example wish papers could be promoted at the city hall or DMV and completed when people apply for a marriage license or a driver’s license. <a href="/resources/download.aspx?id=B817EC7D-1418-4B3C-A4C7-8B11C3342D37" target="_blank" style="color: #FFF; font-weight: bold;">View Entry</a>
  • THE PURPLE ELEPHANT. A marketing campaign that compassionately encourages conversations about death by telling the story of a purple elephant who plans for its own death. The elephant can become a mascot to help overcome cultural taboos around death and dying. <a href="/resources/download.aspx?id=9F168A77-D639-4CA5-B4E4-360E8D75DA46" target="_blank" style="color: #FFF; font-weight: bold;">View Entry</a>
  • MEDICALLY MINDFUL. A website prototype that will assist people in thinking about, learning about, and planning for their advance care directive. Users see why advance care planning is important through “what if” video scenarios and are walked through the completion of relevant forms. <a href="http://share.axure.com/RZLOXD/" target="_blank" style="color: #FFF; font-weight: bold;">View Entry</a>
  • THE QUESTION PROJECT. An education campaign that encourages primary care providers to ask two questions in every visit: Does the patient have an advance directive? Should this patient be considered for palliative care? <a href="/resources/download.aspx?id=37E22CC8-5417-43D9-BF95-E582B57EE8A6" target="_blank" style="color: #FFF; font-weight: bold;">View Entry</a>
  • INTERACTIVE END-OF-LIFE CONVERSATIONS. Dynamic, interactive skits of fictional advance care planning conversations, presented live and followed by discussion with physicians and advance care planning facilitators, to motivate audience members to complete their own advance care plan. <a href="http://vimeo.com/68149252" target="_blank" style="color: #FFF; font-weight: bold;">View Entry</a>
  • TALK TO ME. A video series and website featuring physicians from a variety of specialties relaying personal stories of when their patients, friends, or family experienced a health crisis. The website will include information and tools for patients and providers about how to start the conversation. <a href="/resources/download.aspx?id=764E392C-AA48-487D-9B56-7E625DB1BA70" target="_blank" style="color: #FFF; font-weight: bold;">View Entry</a>
  • VALUE IN PASSING. A financial incentive program that offers a discount on monthly health insurance premiums for those who complete an advance care directive (regardless of the choices made). <a href="/resources/download.aspx?id=3EC0F000-F191-467D-8B3C-CFC8231BEAEF" target="_blank" style="color: #FFF; font-weight: bold;">View Entry</a>
  • TAKE YOUR PATENT'S POLST. A campaign to help hospital staff educate patients on Physician Orders for Life-Sustaining Treatment (POLST) prior to discharge. Considered especially timely for patients who choose a code status of do not resuscitate during their inpatient hospitalization. <a href="/resources/download.aspx?id=2EDF0D96-EEDF-4B75-B7CF-E0E833227190" target="_blank" style="color: #FFF; font-weight: bold;">View Entry</a>

The slideshow above presents the winning and other notable entries out of the dozens of submissions. A panel of judges evaluated each submission based on originality, how well it addresses the problem, consideration of audience needs, and overall quality.

The winning entries were:

  • First place ($5,000): Michael Kersten, master’s candidate in health policy and management at UC Berkeley, for “Advance Care Planning on Facebook: Reaching the Non-activated”
  • Honorable mention ($2,500): The Action Mill team, which includes Nick Jehlen, Rob Peagler, Georgia Guthrie, Jethro Heiko, and Dr. Karl Ahlswede, for “A Gift of Grace”
  • Honorable mention ($2,500): Joanna Hart and Dr. John Hansen-Flaschen with the Fostering Improvement in End-of-Life Decision Science Program, University of Pennsylvania, for “The View from the Bed”

For more information on the challenge, and to see all the submissions, visit the Mad*Pow website through the External Link below.