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Video influences choices on end-of-life care for patients with HF
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Patients with advanced HF who viewed a video outlining various levels of end-of-life care were more likely to choose care that stressed comfort over more invasive care that could prolong life, according to a study published in Circulation.
The 6-minute-long, physician-narrated video featured information and images about three stages of advanced care.
“Because the course of HF is uncertain ... doctors may be reluctant to initiate a conversation with their patients about advanced-care planning,” Areej El-Jawahri, MD, director, bone-marrow transplant survivorship program, Massachusetts General Hospital Cancer Center, Boston, said in a press release. “We found that when patients were better informed, it’s easier ... to discuss end-of-life issues.”
Areej El-Jawahri
The video scenes depicting life-prolonging care included physicians performing CPR and intubation on a mannequin, a ventilated patient in an ICU and medications being administered through a venous catheter.
Limited medical care was depicted with medications given through a peripheral IV catheter, a patient wearing a nasal cannula and scenes from a typical medical ward.
Lastly, the comfort-care section showed patients at home given oral medicines, wearing a nasal cannula and receiving care from a medical assistant.
Cohort breakdown
Researchers analyzed data on 246 patients with advanced HF (mean age, 81 years; 85% white; 61% men) from seven U.S. hospitals from June 28, 2012 to February 7, 2015.
The cohort was stratified into two groups: 123 patients (control) who were only given a verbal description of the three stages of advanced care and CPR/intubation, and 123 patients (intervention) who watched the video and received the verbal description plus an advanced care planning checklist.
Researchers found that in the intervention group, 27 patients (22%) picked life-prolonging care, 31 patients (25%) selected limited care and 63 patients (51%) chose comfort care. Two patients (2%) were uncertain about what type of care they desired. In the control group, 50 patients (41%) chose life-prolonging care, 27 patients (22%) picked limited care and 37 patients (30%) selected comfort care. Eight patients (7%) were unsure (P < .001).
Secondary findings
Other distinctions between the groups included the intervention group being more likely to refuse CPR than the control group (68% vs. 35%, P < .001) and to avoid intubation (77% vs. 48%, P < .001). Also, the intervention group had higher mean scores for knowledge of advanced-care levels (4.1 vs. 3, P < .001) compared with controls.
“After watching the video, patients have a much better sense of what procedures and therapies align with their own values,” El-Jawahri said in the release. – by James Clark
Disclosure: El-Jawahri reports no relevant financial disclosures. For a list of all of the researchers’ disclosures, see the full study.
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