Improving Participation in Advance Care Planning in The Guam/Micronesia Geriatric Community Through Education

The University of Guam (UOG) School of Health (SOH) received a grant in 2019 for the Guam/Micronesia Geriatrics Workforce Enhancement Program (GWEP) funded by the Health Resources and Services Administration (HRSA) of the Department of Health and Human Services (DHHS). The vision of the grant is to transform current health systems serving the elderly and those with Alzheimer’s disease and related dementias. The framework of the 4Ms – what matters, medication, mentation, and mobility is being used to help make this vision a reality through the creation of age-friendly health systems for the elderly. The Guam/Micronesia GWEP chose to focus on what matters out of the 4Ms during years 1-3 of its grant cycle. Specifically, advance care planning (ACP) was addressed at the Guam Memorial Hospital Authority (GMHA) Skilled Nursing Unit (SNU) and in the Guam/Micronesia geriatric community. A chart review was done at the GMHA SNU, which showed low participation in ACP, 25% of the census for that time period. Several reasons for this were revealed through discussion with GMHA SNU personnel. They included lack of awareness or knowledge about ACP as well as language and cultural barriers. After training about ACP was conducted by Guam/Micronesia GWEP, chart reviewed showed participation in ACP improved to 100% at the GMHA SNU. Given this success, the intention is to continue with trainings in ACP through grant year 3 in the hopes of helping patients and their families as well as health care personnel in the Guam/Micronesia community understand how ACP helps to ensure that health care systems respect what matters most to geriatric patients and their families, and in doing so works toward establishing a more age-friendly health system.

Keywords: Advance care planning; GWEP; 4Ms; Guam; Micronesia, Age-friendly health system, Elderly, Barriers to participation in ACP