Testing a Video Decision Support Tool to Supplement Goals-of-Care Discussions
Subject preferences for care at the end-of-life show wide variability. In the setting of advanced disease, some subjects prefer all life-sustaining care while others forgo such procedures. The wide variability in preferences may be due to subjects' misconception of the disease condition when using solely verbal descriptions. The failure to participate in effective goals-of-care discussions may lead to overuse of medical interventions and life-sustaining measures that are inconsistent with patients' and families' wishes. Using video images -- in addition to words -- to convey goals-of-care options at end-of-life, adds a sense of verisimilitude to the condition described and may better inform subjects when making their preferences.
Specific Aim: To assess the effect of a video decision support tool on preferences for end-of-life care in patients and surrogate decision makers consulted on by an inpatient palliative care service. The investigators hypothesize that those subjects who view video images as a supplement to a standard palliative care consult will be more likely to opt for comfort oriented care.
In this study, patient subjects and/or their healthcare proxies who are consulted on by an inpatient palliative care team will be surveyed regarding their preferences for end-of-life care following either a standard palliative care consult or one which utilizes a short video to complement verbal descriptions. The primary analysis will involve the proportion of patient subjects/proxies in each group that prefer comfort oriented care and that die in accordance with their stated preferences. The investigators will also study the effect of the video on patient subjects' and/or proxies' uncertainty with regard to treatment preferences and overall satisfaction with the palliative care consult.
Advance Care Planning
Behavioral: Video Decision Support Tool
|Study Design:||Allocation: Non-Randomized
Intervention Model: Single Group Assignment
Masking: Open Label
Primary Purpose: Health Services Research
|Official Title:||Testing a Video Decision Support Tool to Supplement Goals-of-Care Discussions With Patients and Surrogates Receiving an Inpatient Palliative Care Consult|
- The difference in proportions of patient subjects/proxies in each group (observation vs video phase) who prefer comfort oriented care and who die in accordance with their stated preferences. [ Time Frame: Measured on average within 48 hours of the palliative care service's referral of the subject to the research team, as well as 7-14 days, 2-3 months and 5-6 months post-discharge. ]
- The level of uncertainty regarding treatment preferences. [ Time Frame: Measured on average within 48 hours of the palliative care service's referral of the subject to the research team. ]
- Satisfaction with pain control and symptom management. [ Time Frame: Measured on average within 48 hours of the palliative care service's referral of the subject to the research team, as well as 7-14 days, 2-3 months and 5-6 months post-discharge. ]
- Healthcare proxy satisfaction with end-of-life care following subjects' death. [ Time Frame: Measured at 7-14 days, 2-3 months or 5-6 months post-discharge. ]
- Concordance between patient subjects' and staffs' ranking of symptoms. [ Time Frame: Measured on average within 48 hours of the palliative care service's referral of the subject to the research team. ]
|Study Start Date:||October 2010|
|Study Completion Date:||April 2012|
|Primary Completion Date:||April 2012 (Final data collection date for primary outcome measure)|
Experimental: Video decision support tool
Video decision support tool for goals-of-care options
Behavioral: Video Decision Support Tool
Six minute digital video illustrating specific treatments for three different levels of medical care: life-prolonging care, basic care and comfort oriented care.
No Intervention: Verbal description
Standard verbal description of goals-of-care options provided by an inpatient palliative care team
Please refer to this study by its ClinicalTrials.gov identifier: NCT01391429
|United States, Massachusetts|
|Boston Medical Center|
|Boston, Massachusetts, United States, 02118|
|Principal Investigator:||Michael Paasche-Orlow, MD MA MPH||Boston University|
|Principal Investigator:||Angelo Volandes, MD MPH||Massachusetts General Hospital|
|Study Director:||Nicole LaRue, MD||Boston University|