Diane Meier, MD FACP

Director, Center to Advance Palliative Care

Everyone knows that adults learn best not only through language but also through nonverbal communication: things like the tone of voice, visual images, facial expression, and contextual factors such as trust, a sense of reassurance, and use of plain, clear language. Though we know these things, this knowledge is seldom put to work in helping persons with serious illness and their families to make some of the most medical important decisions they will ever face. Angelo’s use of video breaks through into the often silent world of doctors and patients by using clear, simple, plain language, images of people in similar situations, and a calm, kind context for the information. Clinicians looking to support truly informed decision making for their patients and their families need go no further.

Dartmouth research has demonstrated extraordinary differences in the intensity of the treatment patients receive at the end of life, depending on where they live and who treats them. This suggests there is significant room for improvement, especially in helping patients make informed choices. It is important that patients and caregivers engage in discussions with their doctors that lead to a decision that values the patient’s goals and preferences. This is never easy, but these videos are a powerful tool to help providers communicate choices and to help families reach an informed decision.

DR. JACK WENNBERG
Founder and Director Emeritus
Dartmouth Institute for Health Policy & Clinical Practice
Peggy Y. Thomson Professor Emeritus for the Evaluative Clinical Sciences
DANIEL JOHNSON, MD, FAAHPM
Clinical Lead for Palliative Care at the Care Management Institute, Kaiser Permanente

It’s not uncommon, when a doctor starts a difficult conversation about end-of-life care, for a patient or family member to say, ‘I’m not sure what you mean.’ After viewing these videos, many respond with phrases like, ‘This is very helpful. This helped me to understand better what we’re talking about.’ It’s a difficult task for physicians to translate complex information that can be cluttered in chaotic words into information that’s more easily understood and related to by patients and families. These videos are a way to bridge that gap to help physicians convey this information and support shared decisions.

Whether you’re a patient or a physician, end-of-life care is a difficult topic to approach. But it’s a discussion that patients and their families need to have so they can make informed decisions about their choices. These videos give caregivers a way to start talking about this sensitive subject. Our experience has been that this program and these videos have helped physicians, their patients, and their patients’ families address the issues they need to face around end-of-life care, and make more informed decisions.

HILTON RAETHEL
Chief Health Officer, Hawaii Medical Service Association
MATT HANDLEY, MD
Associate Medical Director, Quality and Informatics
Group Health Cooperative

We have had nothing but good experiences with the videos. They help make the discussion about choices for care easier, and they help make these discussions more patient-centered. They make the discussion less about the illness and more about the patients. The videos don’t replace discussions about decisions, they tee up and facilitate these discussions. The videos are part of our larger effort to ensure patients have the information they need to be active in shared decision-making, and to help physicians understand patients’ values and preferences so they can arrive at the right decision together.