Reach and Impact of a Mass Media Event Among Vulnerable Patients: The Terri Schiavo Story

Abstract

BACKGROUND: It is unknown whether health-related media stories reach diverse older adults and influence advance care planning (ACP). OBJECTIVE:To determine exposure to media coverage of Terri Schiavo (TS) and its impact on ACP. DESIGN AND PARTICIPANTS:Descriptive study of 117 English/Spanish-speakers, aged ≥50 years (mean 61 years) from a county hospital, interviewed six months after enrollment into an advance directive study. MEASUREMENTS:We assessed whether participants had heard of TS and subject characteristics associated with exposure. We also asked whether, because of TS, subjects engaged in ACP.MAIN RESULTS: Ninety-two percent reported hearing of TS. Participants with adequate literacy were more likely than those with limited literacy to report hearing of TS (100% vs. 79%, P<.001), as were participants with ≥ a high school vs. < high school education (97% vs. 82%, P=.004), and English vs. Spanish-speakers (96% vs. 85%, P=.04). Because of TS, many reported clarifying their own goals of care (61%), talking to their family/friends about ACP (66%), and wanting to complete an advance directive (37%).CONCLUSIONS: Most diverse older adults had heard of TS and reported that her story activated them to engage in ACP. Media stories may provide a powerful opportunity to engage patients in ACP and develop public health campaigns.KEY WORDS: mass media; public health; advance care planning; health literacy; vulnerable populations.

Development and Validation of a Questionnaire to Detect Behavior Change in Multiple Advance Care Planning Behaviors

“…Based on our findings, prior advance care planning interventions studies may have grossly underestimated their impact by solely focusing on advance directive completion and not on the processes of behavior change and multiple advance care planning behaviors. For example, a study of the impact of the Terri Schiavo media coverage found that her story motivated 61% of English and Spanish-speaking older adults to define their own goals for medical care and 66% to talk to their family and friends about advance care planning, yet only 3% completed an advance directive [21]. Terri Schiavo's story clearly had a strong impact on this patient population.…”

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“…A influência midiática pode ser notada na procura por serviços de saúde, tanto por atendimentos de emergência quanto no planejamento de intervenções médicas futuras 15,16 . Tal influência também se exerce na estruturação dos sistemas de saúde, nas políticas públicas e no planejamento de recursos 17 .…”

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“…This emphasis on privacy underscores the importance of designating a healthcare agent in order that direct communications are contained only among healthcare providers, the patient, and one or more individuals appointed by the patient. Second, recent media coverage of the Terri Schiavo case, in which family strife developed because a vulnerable patient did not have an advance directive, has apparently resulted in patients' being more willing to talk with family members about such issues and to designate a healthcare agent [9]. Third, Wright and others recently observed that end-of-life discussions led to less aggressive medical care, which in turn spawned improvements in patient quality of life and ultimately gave rise to less bereavement among family members [10].…”