Churches preach virtue of advance care planning

Planning for dying and death is a conversation most Americans avoid. Even though talking through and documenting wishes about end-oflife medical care has been shown to benefit patients and caregivers, only about 1 in 3 U.S. adults have created advance directives, like living wills and other legal documents that inform care when a person can’t communicate their own wishes.

A program in Oakland, Calif., set out to change this — and has recently expanded to Los Angeles on the strength of its positive results.

As in so many aspects of the U.S. health care system, there are racial disparities, too. Among older Americans, just 24% of Black people had advance directives, according to a 2014 study, while 44% of white people did.

Since 2015, the Alameda County Care Alliance has run a free Advanced Illness Care Program (AICP). Founded with local Black churches, the program offers individualized support for people with advanced illnesses and their caregivers. AICP’S trained care navigators belong to the same communities as the participants, helping to build trust in people often wary of the intentions of medical care and research systems.

Care navigators provide structured guidance and assistance in navigating a variety of life issues, from helping locate social services to working through the disquieting questions necessary to create advance directives.

AICP has served more than 1,600 patients and caregivers so far. Three-quarters of participants have been African American, and 55% — far above national averages — have gone on to complete advance directives.

Most clients hear about AICP through local churches, whose leaders were instrumental in identifying the need for a program that creates a bridge between church and health care for those facing advanced illness.

AICP care navigators are trained to offer guidance in several areas: health, spiritual, social, caregiving and advance care planning.

When it comes to advance directives, participants could be at any stage of awareness, from complete unfamiliarity with the concept, to rejection of the idea, to understanding its value but simply not having gotten around to taking action.

To help, the AICP team created a detailed, 23-page Care Planning Workbook, designed with the input of ACCA leadership, care navigators and pastors. The workbook, which also is available to the public as a free download, includes information on what end-of-life treatments are available and guidance on how to have discussions with family, friends and clinicians and select a health care agent.

“We frame it as empowerment,” says care navigator Jae Williams. “We talk about being really clear about your wishes and making sure your loved ones know this, and how actually makes things easier on your loved