Hi Bettina! Thanks for your comments. I just read that JAMA article this morning. 

I believe that one of the key reasons surrogates are not protected from trauma is that we assume that documents created in advance will cover most decisions that come up, but I don't think that's the case. There's too much nuance and uncertainty in the moment, so we need open-ended discussions that help uncover values. That's what I hope would come from this project. 

I think we need to provide better support for the social nature of decision-making both before and after decisions are made. Surrogate decision makers often suffer from the symptoms of PTSD (see http://www.pallimed.org/2011/03/trauma-of-surrogacy.html) and I believe support for clearer conversations before decisions and normalizing the experience of surrogate decision makers after are both important. There are expanding circles of support that can be drawn on for the entire process, and making those explicit and giving people tools to support that process would likely help reduce trauma and encourage people to talk more openly about this process. 

Bettina - Poker and Planning is a great idea! Card games are a great way to support better conversations for seniors (and I'd argue for almost anyone - they're becoming more popular across generations). That was one of the key reasons we designed My Gift of Grace (http://www.mygiftofgrace.com) as a card game and why we recently released event kits that support game events similar to Poker and Planning. You can find out more about those at http://common-practice.com/eventkits and see a talk I gave at the Mayo Clinic's Transform conference on why games support social decision-making here: http://common-practice.com/transform2015