A Randomized Controlled Trial of a CPR and Intubation Video Decision Support Tool for Hospitalized Patients

Areej El-Jawahri MD, Susan L. Mitchell MD, MPH, Michael K. Paasche-Orlow MD, MPH, Jennifer S. Temel MD, Vicki A. Jackson MD, Renee R. Rutledge MD, Mihir Parikh MD, Aretha D. Davis MD, JD, Muriel R. Gillick MD, Michael J. Barry MD, Lenny López MD, MPH, Elizabeth S. Walker-Corkery MPH, Yuchiao Chang PhD, Kathleen Finn MD, Christopher Coley MD, Angelo E. Volandes MD, MPH

Knowledge Level

Subjects in the video arm had more accurate knowledge about CPR and intubation than the subjects in the verbal arm.

Patient Preferences: CPR

64%

Yes to CPR (Verbal Arm)

32%

Yes to CPR (Video Arm)

Patient Preferences: Intubation

72%

Yes to Intubation (Verbal Arm)

43%

Yes to Intubation (Video Arm)

Medical Orders

19%

Order to Withhold CPR

(Verbal Arm)

57%

Order to Withhold CPR

(Video Arm)

19%

Order to Withhold Intubation

(Verbal Arm)

64%

Order to Withhold Intubation

(Video Arm)

Advance Care Planning Discussions

43%

Documented Discussions About ACP Preferences At Discharge

(Verbal Arm)

81%

Documented Discussions About ACP Preferences At Discharge

(Video Arm)

13%

Documented Order to Withhold CPR At Year One Follow-Up

(Verbal Arm)

49%

Documented Order to Withhold CPR at Year One Follow-Up

(Video Arm)

13%

Documented Order to Withhold Intubation at Year One Follow-Up

(Verbal Arm)

53%

Documented Order to Withhold Intubation at Year One Follow-Up

(Video Arm)

Protocol

150

participants

Location

Internal Medicine Service

3:00

minute video

What Patients Think

93%

would recommend the video to others

93%

comfortable watching the video

Randomized Controlled Trial of a Video Decisions Support Tool for Cardiopulmonary Resuscitation Decision Making in Advanced Cancer 

Volandes AE, Paasche-Orlow MK, MItchell SL, El-Jawahri A, Davis AD, Barry MJ, Jackson VA, Gilick MR, Walker-Corkery ES, Chang Y, Lopez L, Bulone L, Mann E, Misra S, Peachey M, Abbo ED, Eichler AF, Epstein AD, Noy A, Levin TT, Temel JS. Randomized controlled trial of a video decision support tool for cardiopulmonary resuscitation decision making in advanced cancer. J Clin Oncol. 2013 Jan 20;31(3):380-6.

Knowledge Level

Subjects in the video arm had more accurate knowledge about CPR than the subjects in the verbal arm.

Patient Preferences: CPR

48%

Yes to CPR (Verbal Arm)

20%

Yes to CPR (Video Arm)

Protocol

150

People with Advanced Cancer

4

Outpatient Oncology Clinics

3:00

minute video

What Patients Think

97%

would recommend the video to others

93%

comfortable watching the video

90%

find the video helpful

Use of Video to Facilitate End-of-Life Discussions With Patients With Cancer: A Randomized Controlled Trial

El-Jawahri A, Podgurski LM, Eichler AF, Plotkin SR, Temel JS, Mitchell SL, ChangY, Barry MJ, Volandes AE. “Use of video to facilitate end-of-life discussions with patients with cancer: a randomized controlled trial.” J Clin Oncol. 2010 Jan 10;28(2):305-10. Epub 2009 Nov 30.

Knowledge Level

Subjects in the video arm were more knowledgeable and certain of their decisions compared to the subjects in the verbal arm.

Patient Preferences: CPR

Patient Preferences: Goals of Care

Yes to CPR (Verbal Arm)

Verbal Arm

CPR: 41% wanted CPR, 59% did not want CPR.

Yes to CPR (Video Arm)

Video Arm

CPR: 9% wanted CPR. 91% did not want CPR.

study-graph-jco

Verbal Arm

Goals of Care: 26% wanted Life Prolonging Care, 52% wanted Limited Medical Care, 23% wanted Comfort Care.

Video Arm

Goals of Care: 0% wanted Life Prolonging Care, 4% wanted Limited Medical Care, 91% wanted Comfort Care.

Protocol

50%

people with malignant glioma

Multiple

outpatient oncology clinics

6:00

minute video

What Patients Think

100%

would recommend the video to others

100%

comfortable watching the video

100%

find the video helpful

Video Decision Support Tool for Advance Care Planning in Dementia: Randomized Controlled Trial

Volandes AE, Paasche-Orlow MK, Barry MJ, Gillick MR, Minaker KL, Chang Y, Cook EF, Abbo ED, El-Jawahri A, Mitchell SL. Video decision support tool for advance care planning in dementia: randomised controlled trial. BMJ. 2009 May 28.

Knowledge Level

Subjects in the video arm were more knowledgeable about advanced dementia and goals of care preferences than the subjects in the verbal arm.

Patient Preferences: Goals of Care

study-graph-dementia-study-2

Verbal Arm

14% wanted Life Prolonging Care

19% wanted Limited Medical Care

64% wanted Comfort Care

After six weeks 27% had changed their preference.

Video Arm

4% wanted Life Prolonging Care

9% wanted Limited Medical Care

86% wanted Comfort Care

After six weeks 6% had changed their preference.

Stability of Preferences

Patients using the video decision support had more stable preferences for end of life care over time.

Protocol

200

people (age 65+)

4

primary care clinics

(2 urban; 2 suburban)

2:00

minute video

What Patients Think

95%

would recommend the video to others

85%

comfortable watching the video

98%

find the video helpful

A Randomized Controlled Trial of a Goals-of-Care Video for Elderly Patients Admitted to Skilled Nursing Facilities

Volandes AE, Brandeis GH, Davis AD, Paasche-Orlow MK, Gillick MR, Chang Y, Walker-Corker ES, Mann E, Mitchell SL. A randomized controlled trial of a goals-of-care video for elderly patients admitted to skilled nursing facilities. J Palliat Med. 2012 May 4.

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evidence-study-randomized-controlled-trial-elderly-legend

Protocol

  1. 6 minute video of the Goals of Care
  2. Randomized controlled trial of 101 elderly patients admitted to a skilled nursing facility
  3. Developed and edited with an expert panel of geriatricians

Viewing Experience

Comfort with the Video: 90% of participants were comfortable watching the video.  86% of subjects would recommend the video to other patients.

Preferences

Verbal Arm: 33% wanted Life Prolonging Care. 8% wanted Limited Care, 57% wanted Comfort Care.

Video Arm: 12% wanted Life Prolonging Care. 8% wanted Limited Care, 80% wanted Comfort Care.

What Patients Think

86%

would recommend the video to others

90%

comfortable watching the video

92%

find the video helpful

Publications

A Randomized Controlled Trial of a CPR and Intubation Video Decision Support Tool for Hospitalized Patients

El-Jawahri A et al. A Randomized Controlled Trial of a CPR and Intubation Video Decision Support Tool for Hospitalized Patients. J Gen Intern Med. 2015 Aug;30(8):1071-80. doi: 10.1007/s11606-015-3200-2. Epub 2015 Feb 18.

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‘We have to discuss it’: Cancer Patients' Advance Care Planning Impressions Following Educational Information About Cardiopulmonary Resuscitation

Epstein AS et al, 'We have to discuss it': cancer patients' advance care planning impressions following educational information about cardiopulmonary resuscitation. Psychooncology. 2015 Dec;24(12):1767-73. doi: 10.1002/pon.3786. Epub 2015 Feb 23.

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A Randomized Controlled Trial of a Cardiopulmonary Resuscitation Video in Advance Care Planning for Progressive Pancreas and Hepatobiliary Cancer Patients.

Epstein AS et al. A randomized controlled trial of cardiopulmonary resuscitation video in advance care planning for progressive pancreas and hepatobiliary cancer patients. J Palliat Med, 2013 Jun;16(6)623-31.

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It Helps Me See with My Heart: How Video Informs Patients Rationale for Decisions about Future Care in Advanced Dementia.

Deep KS et al. Patient Educ Couns. 2010 Nov;81(2):229-34.

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Video Decision Support Tool for Advance Care Planning in Dementia: Randomised Controlled Trial

Volandes AE et al. Video decision support tool for advance care planning in dementia: randomised controlled trial. BMJ. 2009 May 28;338:b2159. doi: 10.1136/bmj.b2159.

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Using Video Images Of Dementia In Advance Care Planning

Volandes A et al. Using video images of dementia in advance care planning. Archives of Internal Medicine, 2007; 167(8):828-33.

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Use Of Video To Facilitate End-Of-Life Discussions With Patients With Cancer: A Randomized Controlled Trial

El-Jawahri A et al. “Use of video to facilitate end-of-life discussions with patients with cancer: a randomized controlled trial.” J Clin Oncol. 2010 Jan 10;28(2):305-10. Epub 2009 Nov 30.

View Publication

A Randomized Controlled Trial Of A Goals-Of-Care Video For Elderly Patients Admitted To Skilled Nursing Facilities.

Volandes AE et al. A randomized controlled trial of a goals-of-care video for elderly patients admitted to skilled nursing facilities. J Palliat Med. 2012 May 4.

View Publication

Augmenting Advance Care Planning In Poor Prognosis Cancer With A Video Decision Aid: A Pre-Post Study.

Volandes A et al. Augmenting advance care planning in poor prognosis cancer with a video decision aid: a pre-post study. Cancer. 2012 Jan 17.

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Assessing End-Of-Life Preferences For Advanced Dementia In Rural Patients Using An Educational Video: A Randomized Controlled Trial.

Volandes A et al. Assessing end-of-life preferences for advanced dementia in rural patients using an educational video: a randomized controlled trial. J Palliat Med. 2011 Feb; 14(2): 169-77.

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Using Video Images to Improve the Accuracy of Surrogate Decision-Making: A Randomized Controlled Trial.

Volandes A et al. Using Video Images to Improve the Accuracy of Surrogate Decision-Making: A Randomized Controlled Trial. J Am Med Dir Assoc, 2009 Oct;10(8):575-80.

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Overcoming Educational Barriers For Advance Care Planning In Latinos With Video Images.

Volandes A et al. Overcoming educational barriers for advance care planning in Latinos with video images. J Palliat Med. 2008; Jun 11(5):700-706.

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Health Literacy Not Race Predicts End-Of-Life Care Preferences.

Volandes A et al. Health literacy not race predicts end-of-life care preferences. J Palliat Med. 2008; Jun11(5):754-762.

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Randomized Controlled Trial of a Video Decision Support Tool for Cardiopulmonary Resuscitation Decision Making in Advanced Cancer

Volandes A et al. Randomized Controlled Trial of a Video Decision Support Tool for Cardiopulmonary Resuscitation Decision Making in Advanced Cancer, J Clin Oncol. Jan 20;31(3):380-386.

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Improving decision making at the end of life with video images

Volandes AE et al. "Improving decision making at the end of life with video images." Medical Decision Making, 30(1):29-34, Jan-Feb 2010.

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Augmenting communication and decision making in the intensive care unit with a cardiopulmonary resuscitation video decision support tool: a temporal intervention study.

McCannon JB et al. Augmenting communication and decision making in the intensive care unit with a cardiopulmonary resuscitation video decision support tool: a temporal intervention study. J Palliat Med. 2012 Dec;15(12):1382-7. doi: 10.1089/jpm.2012.0215. Epub 2012 Oct 25.

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