Advanced Care Planning

Focus Area: End of Life/Advance Care Planning (2011-2016)
Project: Choosing Options, Honoring Options (COHO)


COHO envisions a community that supports an informed and participatory conversation between patients, their loved ones, and their healthcare providers, so that each person facing the final stages of life does so with the greatest possible dignity and comfort. Through this project, we will:

  1. Increase awareness of, and availability of, palliative end of life care resources in the community
  2. Create a culture of acceptance and comfort regarding end of life dialogue and advance care planning
  3. Honor choices about end of life care to the fullest extent possible

Project Goals

  • Increase community awareness of palliative care and end of life resources
  • Improve community level of comfort regarding end of life care conversations
  • Increase prevalence of completion of POLST and/or Advanced Directives

Project Scope

Education around advance care planning and end of life decision-making for the general community in Jackson and Josephine Counties


In January 2011, after selecting End of Life as a JRHA Workgroup focus, the board of directors agreed to become the fiscal sponsor of Choosing Options, Honoring Options (COHO).

Through the work of Dr. John Forsyth and volunteers and staff from 20 local health organizations, COHO created the first public education series on end of life issues. Subsequently, Cambia Health Foundation funded a study to assess the impact on Advance Directive and POLST (Physician Orders for Life Sustaining Treatment) completion numbers using an embedded nurse/social worker in the medical clinic setting at Doctor’s Clinic, Providence Medical Center. As Champion for COHO, Dr. Forsyth was presented the Sojourners Award by Cambia Health Foundation following the publication of the pilot outcomes. This was a cash award which enabled an additional year of funding for the COHO project coordinator position staffed by Susan Hearn. The Cambia funding ended in December 2014 which terminated the paid coordinator position. In preparation for the end of the outside funding, a small group of JRHA members and COHO volunteers established a volunteer Education Committee and they continued to present COHO community education programs around advance care planning into early 2016 supported by consultant Lana Tolls and JRHA staff Angela Warren.

By 2015, the pilot project had run its course. Hospital Palliative Care and Hospice programs had grown and, along with other community organizations, had become primary providers of education and awareness around end of life options and advance care planning. After months of consideration and discussion it became clear to the COHO Education Committee that COHO had served its purpose and achieved what it set out to as a JRHA pilot project. The COHO project’s accomplishments were celebrated and Founder John Forsyth worked with COHO volunteers and JRHA staff to create a final project report.


Founding Community Champion, John Forsyth, MD – Chair 2011-2013; Co-Chairs 2013-2014 – Diane Kosmatka, RN, Providence and Adrienne Goldberg, LCSW, Asante; Chair 2015-2016 – Lois Banke, RN, Parish Nurse

Education Committee

Lois Banke, RN.; Don Bruland, JRHA Co-VP; Pedro Cabrera, RRT; John Forsyth, MD; Susan Hearn, ExD, Southern Oregon Friends of Hospice; Virginia Heenan, OLLI; Joanne Kliejunas, AD facilitator; D’Anne Lenford, InterimHealth; Cheryl Martin, RN Providence Palliative Care; Amanda Morgan, RN, ICU Three Rivers Hospital; Lana Tolls, AD facilitator; Marilyn Watkins, RN

Key Stakeholders

Asante Home Health, Hospice and Palliative Care program; Providence Home Health, Hospice and Palliative Care program; AllCare, Jackson Care Connect, PrimaryHealth; Southern Oregon Friends of Hospice; faith-based groups; senior groups; long-term care facilities; Osher Lifelong Learning Institute (OLLI) at SOU; RVCOG Aging & Disabilities Services

JRHA Relationship

Fiscal agent and administrative staff support