Our Care Wishes
Project status
Collaborators
Susan Kristiniak, DHA, MSN
Scott Halpern, MD, PhD
Josh Rolnick, MD, JD
Innovation leads
Funding
Innovation Accelerator Program
Opportunity
Many patients experience care at the end of life (EOL) that is fundamentally at odds with their preferences. Care that could have been more preference-concordant had their wishes been documented and shared in advance.
Advance care planning (ACP) involves discussing and documenting a patient's wishes for medical care so that if they are too sick to make decisions, loved ones and doctors can carry out preferences on their behalf. ACP enables providers to administer high-value, human-centered, and preference-congruent EOL care.
Unfortunately, many patients do not engage in ACP. The failure to know and follow an individual's EOL care preferences can lead to moral distress among family members, inappropriate utilization of hospital resources, and significant unnecessary costs for patients and health care systems.
Intervention
Our Care Wishes (OCW) is a free digital platform that allows users to document, access, and share advance care wishes from anywhere, with anyone, at any time.
The platform can integrate with Penn Medicine's electronic health record (EHR) so that users can push official advance directives directly to their care team.
Impact
During its tenure, more than 3,500 people documented their wishes on OCW. Eighty-nine percent of those users shared their preferences with at least one care circle member, and 39 percent linked their preferences to their EHR.
Interestingly, when the COVID-19 pandemic struck, research showed that people filled out advance directives at five times the rate they had before and completed more optional goal-setting modules on the platform.
Due to resourcing constraints, this platform has been retired. However, we continue to gain insight into health care decision-making and the benefits of online tools for ACP through the data we have collected.
Innovation Methods
Fake front end
Fake front end
Fake front end
Fake front end
We iterated on the OCW platform many times to improve its design and features.
Before making changes to the platform, we used paper prototypes to gain user feedback and test assumptions. This involved sketching out what new features might look like and how they would work.
The sketches were then put in front of users who interacted with the prototypes as if they were real. These fake front ends helped shed light on how new features might be used and allowed users to provide contextual feedback.