Hawaii Overcomes Cultural Barriers to End-of-Life Care

Establishment of a statewide collaborative program to improve end-of-life care

Between 1999 and 2002, Kokua Mau—a statewide project in Hawaii—took advantage of several legislative and policy changes in the state to educate its public about advance care planning.

Advance care planning involves communicating about one's wishes for future medical care in the event one is unable to communicate them.

The project was part of the Robert Wood Johnson Foundation's (RWJF) national program Community-State Partnerships to Improve End-of-Life Care.

Key Results:

  • Kokua Mau members developed a public awareness campaign to increase the use of advance directives.
  • Project staff encouraged residents of Hawaii to add an advance directive designation to their driver's license or civil identification card.
  • Project staff helped Hawaii's network on aging bring end-of-life care information and resources to its constituency—primarily people 65 and older.

Key Findings: Data reported in 2001 by the University of Hawaii Center on Aging, a member of Kokua Mau, revealed progress on several measures important to this project:

  • The number of residents of Hawaii over 65 years old completing advance directives increased 10 percent from 1998 to 2000, as measured by the statewide Behavioral Risk Factor Surveillance Survey.
  • Some 21 percent of all renewed Hawaiian drivers' licenses in 2002 carried the AHCD, or advanced health care directive, designator.
  • Statewide hospice admissions increased 20 percent from 1999 to 2001, and referrals at the state's largest hospice increased 48 percent during 2002.

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