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National Healthcare Decisions Day (NHDD) is observed annually on April 16 to encourage and empower the public to begin or continue Advance Care Planning (ACP) conversations.

Clear, Concise, Consistent

Richmond, Virginia-based attorney and bio-ethicist, Nathan Kottkamp, MA, JD, launched the observance in 2008 “to provide clear, concise, and consistent information on values-based, healthcare decision-making for individuals, healthcare providers/facilities, and community leaders through the widespread availability and dissemination of simple, free, and uniform tools — not just forms — to guide the process.”  

“Nothing is certain except death and taxes,” declared founding father Benjamin Franklin, and so, Kottkamp choose April 16 — the day after federal tax filings are due — as a time to focus on ACP and to normalize regular review of plans, since decisions about surrogate healthcare decision makers and care preferences likely will change over time. 

A key goal: to demystify healthcare decision-making and make it approachable and accessible by helping people understand that advance healthcare decision-making includes much more than completing a document. It’s a process that should begin with thoughtfully choosing a healthcare decision-maker who is well suited for the role and then prompting conversation about care preferences between the individual and the decision-maker.  

NHDD has grown into a national series of independent events hosted throughout April by hundreds of community groups: healthcare systems, legal services, faith-based organizations, book clubs, and much more. NHDD brings this wide variety of players together to work on a common project to benefit individuals, patients, families, and providers.  

NHDD and ACP at UVA Health

Candace E. Blades, JD, RN, Director, Advance Care Planning, UVA Health, strives to keep the spirit of NHDD alive year-round at UVA Health. Blades is an attorney and a nurse. She is a UVA School of Nursing and University of Maryland School of Law alum who returned to a healthcare setting after practicing law for many years.  

“As a nurse, I worked in an Intensive Care Unit setting,” she recalls. “Watching how a failure to plan for a serious accident or illness created additional burdens for patients, their loved ones, and care teams made a huge impression on me. I decided to shift from a law practice back to a healthcare setting and use my clinical experience and knowledge of the law to focus on improving ACP structures and processes.” 

After being in a similar role at VCU Health for more than six years, Blades came to UVA Health three and a half years ago as the Director for Advance Care Planning. “One of the reasons I wanted to come to UVA Health was the high level of interest in improving ACP practice here. Our leaders understand that providing high quality ACP allows us to provide person-centered, values-based care which aligns perfectly with UVA Health mission, vision, and ASPIRE values.”   

Reliable, Visible, Accessible

An effective ACP program must be built on a solid foundation. To that end, Blades says she has focused on ensuring ACP documentation is reliable, visible, and accessible in the medical record. “We can’t ask care teams to rely on ACP documentation to guide clinical decision-making unless they can find it and trust it,” she explains. 

According to Blades: Epic enhancements have made ACP documentation visible and accessible in the medical record. A collaboration with Health Information Management (HIM) has made this documentation more reliable by ensuring ACP documents are reviewed, validated, and changed to the correct document type prior to being linked to the ACP Navigator in Epic — the “source of truth” for ACP. The next step is to build on that foundation by implementing workflows to help ensure we offer timely, high-quality ACP to all patients and the care we provide is in alignment with known and documented care preferences.  

Get the Tools

Two websites offer plenty of information:

Patients can be guided through the ACP process on UVA Health’s public facing website where they will find: 

• Information needed to understand, reflect on, and communicate choices about surrogate decision-makers and care preferences.     
• Instructions about including ACP documents in the medical record. 
• Links to advance directive forms 

Tools to help healthcare teams provide high quality ACP can be found on UVA Health's internal website: 

• ACP conversation prompts 
• Links to ACP patient education and current forms 
• Information about ACP documentation in Epic 

“Alleviating suffering is the reason many of us were drawn to a career in healthcare,” says Blades. “While we can’t always eliminate it, we help mitigate suffering when we give patients and their loved ones the time and the tools to knowledgeably and thoughtfully plan ahead.”