04 June 2009

Video helps end-of-life care choice

Older people who see a video of a person with advanced dementia are more likely to say they would choose "comfort care" over life-extending treatment if they developed dementia.

Pictures beat words, at least when it comes to making advance care decisions. Older people who see a video of a person with advanced dementia, rather than hearing a verbal description, are more likely to say they would choose "comfort care" over life-extending treatment if they themselves developed dementia, new research shows.

Furthermore, those who see the video are less likely to change their minds about their preferences six weeks later, Dr Angelo E. Volandes of Massachusetts General Hospital in Boston, US, and his colleagues found.

"A video makes these conversations real for patients," Volandes told Reuters Health.

Inform patients of conditions
Understanding complex medical conditions by hearing or reading about them can be difficult, but is increasingly being demanded of patients, Volandes and his team note in their report in the British Medical Journal. With the goal of informing patients more effectively, he and his colleagues produced a 2-minute video of an 80-year-old woman with advanced dementia.

Volandes said they had neurologists, geriatricians, palliative care experts, medical ethicists and decision-making experts review the video to ensure that it was informative and as objective as possible. "This is a pretty fair and accurate picture of what dementia looks like," the researcher said.

To test the impact of viewing this video, Volandes and his colleagues randomly assigned 200 men and women 65 and older to watch the video or to listen to a verbal description of advanced dementia. Study participants were then asked what their preferred type of care would be if they developed advanced dementia.

Among the people who only heard the verbal narrative, 64% said they would choose comfort care, compared with 86% of those who saw the video.

Video has bigger impact
The corresponding proportions for those opting for limited care (including admission to the hospital if needed and antibiotics, but not CPR) were 19% and 9%, for life-prolonging care the rates were 14% and 4%, while 3% and 1% said they weren't sure.

When the researchers contacted the study participants again six weeks later, they found that 29% of people in the description-only group had changed their mind about their care preferences, compared to 6% of people who saw the video.

Volandes and his team are developing other visual tools to help people make medical decisions, including videos of patients with advanced cancer, advanced heart failure, and advanced lung disease, as well as videos portraying medical procedures such as cardiopulmonary resuscitation and intubation.

These videos can ensure that people understand what a disease or a procedure is really like, Volandes said, rather than basing their perceptions on what they see in television dramas.

While much more work needs to be done to determine how to incorporate these videos into the doctor-patient relationship before they can be made widely available, Volandes said, he anticipates the approach will become the standard of care for helping patients make end-of-life decisions. - (Anne Harding/Reuters Health)

SOURCE: BMJ Online First, May 28, 2009.

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