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What is an advance directive? When is it time for palliative care? What do Catholic teachings have to say about these topics? Some of the most difficult questions people ever face concern how to care for loved ones in the final stages of life.

In November, a priest and a doctor in Syracuse, New York, launched Project Compassion, a website designed primarily for Catholics struggling with these issues. The idea was born during ongoing conversations over coffee. The more Fr. Charles Vavonese and Dr. Paul Fiacco talked about end-of-life topics, the more they wanted to find a way to offer spiritual and medical guidance on a large scale.

Years before the website was rolled out, the pair wrote 13 articles on end-of-life topics for the Catholic Sun, the official newspaper of the Roman Catholic Diocese of Syracuse. They made presentations on the subjects they'd written about, including grieving, the role of hope at the end of life and legal issues related to end-of-life care.

The response was overwhelming. But as successful as their efforts were, they still weren't reaching enough people. "People kept saying, 'You've got to do more, '" says Fr. Vavonese, director of Project Compassion.

A different experience
Fr. Vavonese and Fiacco began planning an ambitious website. They wanted to provide resources for patients diagnosed with serious illness, their families and caregivers, as well as lay ministers, health care providers and the general public. They envisioned explanatory videos, a pastoral care training program and a polished, professional look. But all that would cost money.

At the time, both men worked for Syracuse's St. Joseph 's Health, a member of Trinity Health. They collaborated with St. Joseph's Health Foundation to apply for a grant from the Mother Cabrini Health Foundation, a nonprofit that supports health and well-being initiatives in New York state. The application was approved for $500,000.

"We were lucky," Fr. Vavonese says. "With a half million, you can do a lot."

They selected a web-hosting company and hired a retired local newscaster and a videographer who once worked for the diocese. The team shot and produced 19 videos on subjects that range from pain management to spiritual questions about the ubiquitous experience of death.

"It's going to happen to you; it's going to happen to me," says Fiacco, Project Compassion's medical director.

But as inevitable as death is, much about the way Americans die has changed over the past century, Fiacco says. People once died quickly from infectious diseases such as pneumonia, polio and tetanus. Even then, when little could be done medically, holistic care was the norm in Catholic hospitals.

Thanks to antibiotics and immunizations, many people now survive once-fatal conditions. The causes of death today are more likely to be heart disease, cancer or diabetes — diseases people can live with for months or years. During this time, health care providers can give primary palliative care, which eases the symptoms of the disease but cannot cure it. This care is multidisciplinary and includes emotional and spiritual social care.

"Doctors are trained very well to attend to the physical needs," Fiacco says. "But what about the emotional and spiritual journey?"

Doctors who want to delve deeply into end-of-life issues and palliative care options with patients and their families often don't have the time.

"The website is an attempt to say to the patients, 'OK, I can't have all these conversations with you, but I want to provide this holistic kind of care,'" Fiacco says.

Primary palliative care
It's imperative to begin talking about primary palliative care as soon as possible, Fiacco says. For example, a diagnosis of pancreatic cancer should immediately be paired with a conversation about palliative measures. The website videos provide a way for families to talk about it.

While many of the videos hold value for non-Catholics, Catholicism is at the heart of the project. For instance, since many Catholics worry about the sanctity of life versus the need for medications like morphine, the website addresses the ethics behind such decisions, according to Fr. Vavonese.

"Administering the pain medication at the end of life might shorten a life, but using the moral principle of double effect, we as Catholics are permitted to do that — after meeting certain criteria," Fr. Vavonese says.

This kind of guidance can be life-changing for caregivers and family members. Fr. Vavonese remembers one man who cried when he learned the decisions he'd made for his dying wife were consistent with Catholic teachings.

"He said, 'Now that you've told me I did the right thing, I'm not worried anymore,'" Fr. Vavonese says.

The future
Given the reality that there are fewer clergy, the website includes pastoral care training for lay ministers to meet the need to provide spiritual support to those receiving primary palliative care. Since the training is continually available online, people no longer have to wait to enroll in in-person training that might not start for several months.

"Now if somebody walks into the parish and says, 'I'd like to become a Eucharistic minister,' it's very easy for the pastor to say, 'Here's some training for you,'" Fr. Vavonese says, referencing a video on Project Compassion that trains lay ministers who visit the sick and homebound.

Fr. Vavonese and Fiacco are working to let more people know about the pastoral care training. One initiative would promote the series to those involved in prison ministries. Another idea in the works would make Project Compassion a resource in the Community Division of Trinity Health, which includes visits with providers in the medical group and care managers outside the hospital.

Shelia Johnson, vice president of population health clinical operations at Trinity Health, was among those who reviewed the grant application for Project Compassion for Mother Cabrini Health Foundation.

"I was struck by how it would help more laypersons become involved in pastoral care, as well as help our patients who are suffering," Johnson says.

Fr. Vavonese and Fiacco are still waiting to receive data that shows the number of people who visit the Project Compassion website. But they do know people from countries including India and China have sought guidance there.

Johnson is excited about what Trinity Health — with 101 hospitals in 27 states — could do to boost a site she considers invaluable.

"When I went on it, I was able to find everything; it's organized, the content is very professionally developed and it's easy to understand," Johnson says. "Having all of this in one place is just a wonderful idea."