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Health Care Design Conference - 2013 Boston


End-of-Life Care Challenge from the California HealthCare Foundation: Catalyzing Communication about End-of-Life Care


Michael Kersten: Advance Care Planning on Facebook: Reaching the Non-activated

The Action Mill and Dr. Karl Ahlswede: A Gift of Grace

Joanna Hart, John Hansen-Flaschen, MD: The View from the Bed

View All Challenge Submissions

Challenge Overview

In a 2012 study of Californians’ attitudes and experiences with death and dying, 60% of respondents said that making sure their family is not burdened by tough decisions about their care at the end of life is “extremely important.” Yet 56% had not communicated their end-of-life wishes to the loved one they would want making decisions on their behalf, and only 23% said they have their wishes in writing.

People may record their end-of-life wishes using legally recognized documents such as advance directives and, depending on where they live and their level of health, Physician Orders for Life-Sustaining Treatment (POLST).

Advance directives, which include living wills and medical powers of attorney, are legal documents that record the individual’s wishes for end-of-life care. Advance directives should be filled out while people are healthy, because doing so gives them time to think about the end-of-life care they would choose if they were unable to communicate their own wishes. It also allows time to discuss these wishes with loved ones.

POLST is a form that clearly states what kinds of medical treatment people want toward the end of their lives. Printed on brightly colored paper and signed by both the doctor and the patient, POLST helps give seriously ill individuals more control over their treatment.

Many tools have been designed to guide people through having the conversation about their wishes and completing relevant forms, yet a low percentage of people act on these opportunities.

When surveyed about the main reason(s) why they had not talked to their loved ones, 41% of Californians said they had too many other things to worry about right now, and 39% said that they or their loved one didn’t want to think about death or dying. Completion rates also vary based on race and ethnicity.

When people’s voices aren’t heard, either in a document or conversation, they are less likely to get the care that is in line with their preferences. How can we get more people to complete advance directives early, re-visit them periodically, and for people with serious illness document their end-of-life wishes (e.g. POLST)?

Your Challenge

Bring your empathy and creativity to bear on this challenge, and help us develop new approaches to catalyze people toward making their wishes known.

  • Submissions should promote awareness and create a compelling experience that leads to greater activation and more people communicating their preferences by having a conversation, and completing an advance directive or POLST form.
  • Submissions should target non-activated people, and help take a person from pre-contemplation to contemplation, or contemplation to action. (We can assume that activated people can and will do this on their own.)
  • Submissions should not create additional advance care planning documents; existing forms and documents can be used.


  • Submission Period Begins: March 25, 2013
  • Submission Deadline: Friday, May 10, 2013, 11:59 pm PDT
  • Winners Announced: May 29, 2013

Proposed solutions may take a variety of forms—including but not limited to a website or mobile app, a physical product, a marketing campaign, or an art installation. A number of paper and digital tools already exist, so we are looking for creative approaches that use any medium to get people aware, thinking, talking, and taking action. Submit whatever you need to convey your idea, within the following guidelines:

  • REQUIRED: Design brief of 500 words or less summarizing your solution and process
  • REQUIRED: PowerPoint slideshow or video (max. 15 min) that visually communicates your solution
  • EXTRA CREDIT: Any other supplemental documentation that helps communicate your ideas or design process

To submit please download the official entry form, and submit as an email attachment to

If you are creating a video, you will need to upload it to YouTube, Vimeo, or similar. Other forms of documentation may be submitted via email (up to 20MB) or by providing a link to view or download. Please state in your submission whether you are addressing advance directives, POLST, or both.

After judging, entries will be shared publicly to inspire the community to continue the conversation around solutions for this important issue.


A panel of judges will evaluate each submission based on originality, how well it addresses the problem, consideration of audience needs, and overall quality. Participants are strongly encouraged to incorporate user research into their design process and mention this in their submissions.


  • $5,000 – Best Overall Solution
  • $2,500 – Honorable Mention
  • $2,500 – Honorable Mention

Terms and Conditions

All participants will be guided by the following terms and conditions:

  • Must be a U.S. resident, business, or non-profit entity to enter
  • You may enter as an individual or small team (~5 people). Please only one submission per entrant
  • Participants retain their rights in the designs they develop, giving the California HealthCare Foundation rights to publish, implement, use and expand on submissions
  • Employees of the California HealthCare Foundation and Mad*Pow are not eligible to participate
  • View complete design challenge rules

Existing Tools


Get Your Shit Together

The Conversation Project

Easy to Use California Advance Health Care Directive

American Bar Association Commission on Law and Aging Resource List

Additional Resources

California HealthCare Foundation – Video Reflections on End of Life Care

NPR – The Diane Rehm Show – “Family Conversations About End-Of-Life Care”

The Boston Globe – Dr. Angelo Volandes – “More help navigating end-of-life options can improve care for dying patients — and reduce costs”

Fried, et al. – Patient Education and Counseling – “Promoting Advance Care Planning as Health Behavior Change: Development of Scales to Assess Decisional Balance, Medical and Religious Beliefs, and Processes of Change”

CDC – Advance Care Planning Selected Resources for the Public

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