Vineyarders need to begin encouraging more thoughtful discussion about end-of-life plans, eight rural scholars from the University of Massachusetts medical school concluded in a recent mini-study on the Island.

The rural scholars program, where a group of medical students intensively study a public health topic, began in 2000 and has included research on a wide range of topics, including Lyme disease, food security, addiction, homelessness and isolation among the elderly.

This time medical and nursing students embedded in the Vineyard community for two weeks to study advance care planning. Findings were presented last Thursday afternoon at the West Tisbury Library.

End of life planning is a public health issue because it allows people to be thoughtful agents in their own care, Dr. Daniel Pesch said in opening remarks. Dr. Pesch is an obstetrician at the Martha’s Vineyard Hospital, which along with Healthy Aging Martha’s Vineyard, partnered with UMass Worcester for the project.

“Lack of appropriate advance care planning leads to a lot of unintended, unwanted care and confusion in the process,” Dr. Pesch said.

The students — six of the scholars are second year medical students and two are studying to be nurse practitioners — conducted interviews with more than 45 stakeholders on the Island.

They defined advance care planning as a thoughtful discussion about how a person wishes to spend the end of his or her life. Scholars said the conversation should involve the person who is aging, family members and a health care provider and should be documented, both legally and informally.

In an aging community where many residents live far from their relatives, planning for end-of-life care is a must, the scholars said

“There’s an increasing population of older adults who really intend to spend the rest of their lives in this community,” said medical student Julia Oppenheimer said. The study also involved an examination of available resources available on the Island. Scholars commended existing efforts to destigmatize death, such as the death cafes held at the West Tisbury Library three times a year. Faith leaders who are engaged and existing support networks such as the councils on aging were also cited as positives.

“This is a small community where people really care about each other,” Ms Oppenheimer said.

But the scholars also found obstacles to good end-of-life planning, including a shortage of primary care doctors, geographic isolation from family members, lack of resource coordination and cultural barriers.

Better coordination of resources and collaboration among different organizations were recommended. Among other things, the scholars propose that Island faith leaders collaboratively host an annual end-of-life planning event. They also recommend that medical providers be informed about community resources available for advance care planning in order to tell their patients.

The scholars also found that more cultural change is needed on the Island to destigmatize the topic of death at all ages.

“It’s never an easy subject to talk about death, and Americans haven’t done a good job of accepting it as one of the realities of our lives,” said Paddy Moore, a founder of Healthy Aging MV, in introductory comments.

The scholars said it is never too early to talk about dying and suggested the topic be discussed in the high school, possibly along with driver education. They recommended primary care providers begin to broach the topic with all patients, not just those are elderly.

“We believe that primary care is the best setting for this to take place . . . so what we propose and recommend is having these conversations in the primary care office, not at end of life, but in middle age and even younger as well,” said medical student Richard Moschella.

The scholars outlined several specific planning aid documents, including a living will, health care proxy and other legal documents that spell out a person’s wishes in the event of a debilitating illness or health crisis.

“Start the conversation now,” said student Jessica Kloppenburg. “At home with friends and family, and with health care provider.”