AIM: The Conversation Project
Get ready to talk about end of life at every age
When Todd Shields turned 40 this year he wrote down a list of 40 things he wanted to accomplish before he turns 41. One of them, he said, had to do with creating a will and talking about his end-of-life wishes with his wife.
"My best friend growing up passed away last year at 38,
suddenly. I think about it all the time," said Shields, the
Centers of Care director for St. Charles Health System. "I don't
want my family to be burdened. I don't want them to have to
second guess or have doubt."
To get started on the process, Shields met with Katie
Hartley and Dr. Laura Mavity, directors of the St. Charles
Advanced Illness Management Center of Care, to learn
about The Conversation Project. St. Charles is one of 12
health systems in the country selected to participate in the
Institute for Healthcare Improvement's Conversation Project
as a pioneer sponsor.
"The transformative goal is to have every person's end-of-life
wishes expressed and documented," Hartley said. "We know
that 82 percent of people say it's important to put their wishes
in writing, but only 20 percent of people actually do. Seventy
percent of people say they would like to die at home, but in
reality 70 percent of people die in a hospital, nursing home or
other care facility."
The Conversation Project website provides a tool kit to help
people of all ages think about what matters most to them,
what brings them joy and what they would consider to be
an acceptable quality of life. It also walks people through
the legal steps of documenting end-of-life wishes including
completing an advanced directive and a POLST — physician
orders for life-sustaining treatment — form.
Because St. Charles is a pioneer health system for The
Conversation Project, Hartley and Mavity are launching
several pilot projects in an effort to introduce the toolkit to the
Central Oregon community. Mavity attends St. Charles' new
Heart Failure University to present The Conversation Project
and Hartley follows up with a phone call to participants to
see if they have visited the website and started on their own
conversations with their loved ones.
"It's hard. Having those conversations is hard," Mavity said.
"It's talking about things you hope won't happen, but are
going to happen at some point. Having these conversations
means embracing our mortality."
As a palliative care specialist, Mavity regularly sees first-hand
how difficult it can be for families to make decisions about care
if they don't know what their loved one would have wanted
and the loved one can no longer speak for him or herself.
"When people haven't had these conversations, the risk
is they can receive health care that they wouldn't want —
whether that is overly aggressive or under aggressive,"
Mavity said. "If we have some sense of what they would have
wanted, that is always the right decision."
For more information on The Conversation Project visit