With the advent of the New Year, many people make a point of setting New Year’s resolutions or goals. With the pandemic still raging around us, we would like to suggest that it would be wise to set a goal to visit www.planwellguide.com and complete your serious illness planning as soon as possible this year. Recent evidence which summarized the results of 69 randomized trials of advance care planning interventions highlighted how thinking ahead and preparing in advance for serious illness will significantly improve your mental well-being (or reduce your rates of anxiety and depression) as well as improve the mental well-being of your substitute decision-maker (reduce their rates of depression, anxiety, post-traumatic stress disorder, complicated grief and caregiver burden).[i] Think of how incredibly helpful it would be in both your life and the life of the family member that may need to step in and help make life and death decisions for you, if you have your plans already in place!
The harsh reality is that for many of us, we may not ever realize a particular New Year’s resolution. For example, one study surveyed obese patients about their weight loss goals and showed that only 9% had experienced success in the two years that followed with sustained weight loss.[ii] For those setting a goal to quit smoking, only 19% reported abstinence at the two-year follow-up.[iii] You may be reading this thinking, well what is the point then, why bother setting a goal or resolution? Well, we still want to encourage goal setting as there is evidence that people who set goals and make such resolutions are more likely to achieve success with sustainable adoption of better life-style habits than those that don’t make such resolutions.[iv][v]
At Plan Well Guide, we are committed to helping you think ahead and set goals for a better future. In 2021, we will roll out additional tools to help you be more successful in planning for your future. For now, amidst a global pandemic, we’ve thought more deeply about how to better encourage people to finalize their serious illness plans. We have come up with the following evidence-based strategies:
As defined on Wikipedia, “A nudge is any aspect of the choice architecture that alters people’s behavior in a predictable way without forbidding any options or significantly changing their economic incentives.”[vi] In other words, it is a strategy to change a person’s behavior that doesn’t rely on direct commands, legislations or regulations, or pricing options. Nudges ‘gently’ try to influence the choices available to a person at the point of decision-making so as to make it easier to comply with the desired behavior from a public health or societal perspective.
A good example of this is a recent randomized trial of a ‘poster’ in hospital-based confectionaries. It is well known that people overconsume high calories snacks and that most of these high-calorie snacks are not intentional but bought spontaneously when out of the house. Why do you think retailers put chocolate bars, candies and other high calorie snacks at the check-out register? Because they know that by having them there, you are more likely to buy them on your way out. But what if, at this point of decision-making, you saw a poster that alerted you to the caloric content of these snacks and you were able, at a glance, to see how healthier snacks compared. Would that influence your decision-making? Researchers working in hospital confectionary shops showed that in fact, this ‘nudge’ at the point of decision-making was effective at improving snack choices and reducing sugar and caloric intake.[vii] Now, you are probably wondering how does this apply to serious illness planning? The answer is, there are in fact many points in a person’s life when they are poised to ‘think ahead and plan ahead.’ Examples of this could be something such as:
What if, at each of these decision points, there was a ‘nudge’ to engage in serious illness preparations and planning? The truth is that most people will require multiple nudges from trusted advisors before they engage in the desired behavior. Our goal at Plan Well Guide is to partner with more doctors and planning professionals, like the lawyers or financial planners referenced in the example above, so people receive multiple nudges when primed to think about their future. If you are a doctor or planning professional and would like to provide greater value and support to your patients and clients in helping them prepare for serious illness, we encourage you to send us an email, so we can discuss potential partnerships.
Systematic reviews of electronic health (often referred to as e-health) or internet-based health promotion interventions consistently conclude that these interventions designed to aid in shifting difficult-to-change behaviors, such as quitting smoking, eating healthier, or increasing physical activity are effective in changing a broad range of healthy behaviors.[viii, ix, x, xi] They also conclude that internet-based interventions, such as Plan Well Guide, can increase their impact on behavior change by using email as an additional mode of delivery.4 Appealing to this dataset, we’ve developed an electronic messaging or e-messaging system that will provide the user with a series of prompts or reminders every two weeks until the completed task is done.
This year, in 2021, our New Year’s goal at Plan Well Guide is to help more people finalize their serious illness preparations and plans. The COVID-19 pandemic puts some urgency to this task, particularly for older people. In order to be more successful in helping you, we are embarking on a strategy to partner with other doctors, lawyers, and other planning professionals, to amplify our call to action so that people receive multiple nudges from their trusted advisors.
By combining that with an e-messaging strategy that all these professional partners can send to their patients or clients or you as an individual can sign up for, we are confident we will have a greater impact when it comes to helping people prepare and plan!
Wishing you a Happy and healthy New Year ahead!
[i] McMahan, R.D., Tellez, I. and Sudore, R.L. (2020), Deconstructing the Complexities of Advance Care Planning Outcomes: What Do We Know and Where Do We Go? A Scoping Review. J Am Geriatr Soc. doi:10.1111/jgs.16801
[ii] Rössner SM, Hansen JV, Rössner S. New Year’s resolutions to lose weight–dreams and reality. Obes Facts. 2011;4(1):3–5. doi:10.1159/000324861
[iii] Marlatt, G. A., Curry, S., & Gordon, J. R. (1988). A longitudinal analysis of unaided smoking cessation. Journal of Consulting and Clinical Psychology, 56(5), 715–720. https://doi.org/10.1037/0022-006X.56.5.715
[iv] Norcross, John & Mrykalo, Marci & Blagys, Matthew. (2002). Auld Lang Syne: Success Predictors, Change Processes, and Self-Reported Outcomes of New Year’s Resolvers and Nonresolvers. Journal of clinical psychology. 58. 397-405. 10.1002/jclp.1151.
[v] Samdal GB, Eide GE, Barth T, Williams G, Meland E. Effective behaviour change techniques for physical activity and healthy eating in overweight and obese adults; systematic review and meta-regression analyses. Int J Behav Nutr Phys Act. 2017;14(1):42. Published 2017 Mar 28. doi:10.1186/s12966-017-0494-y
[vii] Allan, J.L., Powell, D.J. Prompting consumers to make healthier food choices in hospitals: a cluster randomised controlled trial. Int J Behav Nutr Phys Act 17, 86 (2020). https://doi.org/10.1186/s12966-020-00990-z
[viii] Webb T, Joseph J, Yardley L, Michie S. Using the Internet to Promote Health Behavior Change: A Systematic Review and Meta-analysis of the Impact of Theoretical Basis, Use of Behavior Change Techniques, and Mode of Delivery on Efficacy. J Med Internet Res 2010;12(1):e4
[ix] Broekhuizen K, Kroeze W, MNM van Poppel, Oenema A, Brug J. A Systematic Review of Randomized Controlled Trials on the Effectiveness of Computer-Tailored Physical Activity and Dietary Behavior Promotion Programs: an Update. ann. behav. med. (2012) 44:259–286 DOI 10.1007/s12160-012-9384-3
[x] Hutchesson, M.J., Rollo, M.E., Krukowski, R., Ells, L., Harvey, J., Morgan, P.J., Callister, R., Plotnikoff, R. and Collins, C.E. (2015), eHealth interventions for obesity in adults. Obes Rev, 16: 376-392. doi:10.1111/obr.12268
[xi] Podina, I. R., & Fodor, L. A. (2018). Critical review and meta-analysis of multicomponent behavioral e-health interventions for weight loss. Health Psychology, 37(6), 501–515.