End-of-life planning should be a piece of cake


After you are gone, should your Facebook profile be deleted?  Do you have a health care proxy who will make medical decisions for you when you can’t? Burial or cremation? And what music should be played at your funeral?

An emerging startup called Cake wants to make advance care and end-of-life planning a simpler process for all of us – a piece of cake, if you will. The Cake team was a finalist in this year’s MassChallenge startup accelerator. They are collaborating with Brigham Innovation Hub (iHub) the unit of Brigham & Women’s Hospital that helps innovators turn ideas into products and services.

Cake is now signing up people for its second round of beta testing.

“Right now end-of-life planning is complicated, over-legalized, full of medical jargon and seems like a chore few would want to get down to,” says the 34-year-old co-founder of Cake, Suelin Chen. “It is like doing taxes, except there is no deadline, and so this task can be put off indefinitely.”

As a graduate student at MIT, Chen designed nanoparticles to image tumors. The work took her to Massachusetts General Hospital where she saw cancer patients and their families cope with the life-altering illness. After graduating, Chen worked in life sciences-related consulting but the experience in the cancer wards made an impact.

Last fall, the material scientist started My Exit Strategy, a startup whose goals was to create easy-to-use online tools to help users with end-of-life planning.

Earlier this year, at the MIT Hacking Medicine conference, Chen met Dr. Mark Zhang, 32, a palliative care physician and Clinical Informatics Fellow at Brigham and Women’s Hospital. They participated in the Grand Hack, and won. Zhang became co-founder of the startup.

Chen had identified the four pillars of end-of-life planning: healthcare, financial, funeral and legacy. Now they needed an intuitive interface to ease people into making decisions, by helping them discover their personal preferences. “We wanted to focus on the fact that the only reason to plan for end of life is to make living better,” says Chen, an idea which is reflected in the name change.

Cake’s free app, which can be used on smartphones, tablets, or computers, helps the user create a secure online document of instructions to share with loved ones, physicians and lawyers, either for themselves, or for someone they care about.

Here is how Cake will make money: People may need help to accomplish their objectives and so startup offers some of these services in-house, for others it will refer users to service providers such as estate attorneys or insurance companies. “We are also in discussions with HR managers who want to offer Cake as an employee benefit,” says Chen.

Some members of the medical community like the concept. “I think Cake is an excellent way to engage people in thinking about their end-of-life care decisions and choices. It encourages discussion with friends and families to ensure that one’s wishes are known and fulfilled,” says Dr. Kathy Selvaggi, the Division Chief-Palliative Care at the Butler Health System in Pennsylvania.

Cake also facilitates difficult those face-to-face conversations with friends and family, so a customer’s choices are understood by their loved ones. “Otherwise designating a health care proxy is pointless,” emphasizes Chen, “You might as well tear up that document.”

Beta testing showed that the app appeals to users of all age groups. “The key thing is that you have these windows of opportunity throughout your life when you want to think about end-of-life: experiencing a loss, getting married, having kids, a loved one getting sick – it does not correlate with age at all,” Chen says.

For instance, as they prepared for the arrival of their first child, Caroline Runyan, a postdoctoral researcher at Harvard Medical School, and her husband tried Cake’s concierge service. They met the end-of-life expert, and came away with a set of goals, along with a road map to get there. “Within just a few weeks, we had life insurance policies in place that we feel very good about,” says Runyan, adding that the process helped them address matters that would have otherwise waited till some unforeseen future crisis.

Most people want to have a conversation about end of life with their doctor, but there either isn’t time, or it feels awkward. Tools like Cake lower the barriers to have quality advance care discussions,” says Lesley Solomon, Executive Director of Brigham’s iHub. The app could be the ice breaker.

Bootstrapping has allowed the founders – both of whom work without pay – to maintain control of their startup. Others on the team offer sweat equity. They’ve won cash awards; they receive in-kind support from MassChallenge. By the end of the year, they plan to go in for seed funding.

Updated at 12:54 p.m. Tuesday to correct the spelling of Caroline Runyan’s name.