# I kua na'u "Let Me Carry Out Your Last Wishes" Advance Care Planning for Native Hawaiian Elders

> **NIH NIH R01** · BOSTON MEDICAL CENTER · 2021 · $699,871

## Abstract

Communication surrounding serious illness decision making is formalized in Advance Care Planning (ACP), a
process involving verbal or written information designed to inform patients of possible medical options including
palliative and hospice care services. Numerous studies have suggested that improved ACP rates better align
health care delivery with patient preferences. Despite expansion of ACP services in the health care system,
Native Hawaiians (NHs) consistently have negligible rates of ACP and low use of palliative and hospice care
services. To address these shortcomings, our multi-disciplinary community and research group has partnered
to create the I kua na'u "Let Me Carry Out Your Last Wishes" ACP video intervention. Our Community-Based
Collaborative Approach will create, develop and test the I kua na'u comprehensive video-based ACP program
honoring the history, opinions, and culture of NHs. Indeed, NH culture is primarily an oral tradition in which the
spoken word permeates the life of NHs and is the normal way of interacting with neighbors, including in its
most recent adaptation with the use of video media. The I kua na'u program will include videos tailored for the
different settings in which older NHs live and get medical care. The videos will explain the importance of ACP,
empower NHs to tell their story ('olelo Kama'ilio; "Talk Story") by allowing the recording of personal video
declarations of ACP wishes, and the ability to share the personal video declaration with family, friends and
clinicians. The overall objective is to conduct a five-year program that includes two years of development of the
I kua na'u ACP video program with focus group testing, and then three years of implementation in the NH
community. Demonstrating the effectiveness of using the video program in NHs represents an essential step to
implement this tool in practice. The Specific Aims are: (1) To conduct focus groups and group interviews of NH
elders, their families, and their providers to inform the creation and pilot-testing of NH ACP videos that would
embrace the NH concept of I kua naʻu - "Let me help carry out your last wishes" among three different types of
organizations serving NH elders and their families (NH Homestead, Group Assisted Living, and Ambulatory
Care). (2) To compare the ACP engagement, knowledge, decisional conflict, and ACP completion rates in 220
NHs over the age of 55 in: (a) a pre-post study design in 110 people living on Homestead or Assisted Living
using the video intervention, and (b) a randomized trial of 110 people recruited from Ambulatory Clinics. (3) To
conduct a qualitative assessment of personal video declarations from 165 NHs using the intervention. (4) To
compare ACP documentation and end-of-life health care utilization of NHs compared to non-NHs living in
Hawaiʻi before and after the intervention program using electronic health records and/or insurance data.
Conventional ACP programs do not meet the unique needs of NHs. Cr...

## Key facts

- **NIH application ID:** 10168656
- **Project number:** 5R01NR018400-02
- **Recipient organization:** BOSTON MEDICAL CENTER
- **Principal Investigator:** Marjorie K. Leimomi Mala Mau
- **Activity code:** R01 (R01, R21, SBIR, etc.)
- **Funding institute:** NIH
- **Fiscal year:** 2021
- **Award amount:** $699,871
- **Award type:** 5
- **Project period:** 2020-05-20 → 2025-02-28

## Primary source

NIH RePORTER: https://reporter.nih.gov/project-details/10168656

## Citation

> US National Institutes of Health, RePORTER application 10168656, I kua na'u "Let Me Carry Out Your Last Wishes" Advance Care Planning for Native Hawaiian Elders (5R01NR018400-02). Retrieved via AI Analytics 2026-05-22 from https://api.ai-analytics.org/grant/nih/10168656. Licensed CC0.

---

*[NIH grants dataset](/datasets/nih-grants) · CC0 1.0*