Efficacy of Advance Care Planning Videos for Patients: A Randomized Controlled Trial in Cancer, Heart, and Kidney Failure Outpatient Settings

Abstract

Background Patient videos about advance care planning (ACP; hereafter “Videos”), were developed to support uptake of provincial policy and address the complexity of patients’ decision-making process. We evaluate self-administered ACP Videos, compare the studies’ choice of outcomes, show correlations between the patients’ ACP actions, and discuss implications for health care policy. Objective To test the efficacy of the Videos on patients’ ACP/goals of care designation conversations with a health care provider. Design, Setting, and Participants Using a 2-arm, 1:1 randomized controlled trial, we recruited outpatients with a diagnosis of kidney failure, heart failure, metastatic lung, gastrointestinal, or gynecological cancer from 22 sites. Analysis followed the intention-to-treat principle. Interventions Videos describing the ACP process and illustrating the resuscitative, medical, and comfort levels of care. Main Outcomes and Measures The primary outcome was the proportion of participants who reported having an ACP/goals of care designation (GCD) conversation with a health care provider by 3 mo. Outcomes were measured using the Behaviours in Advance Care Planning and Actions Survey, an online survey capturing ACP attitudes, processes, and actions. Results We analyzed 241 and 217 participants at baseline and 3 mo, respectively. The proportion of participants who had an ACP/GCD conversation with a health care provider by 3 mo was significantly different between study arms (46% intervention; 32% control; adjusted odds ratio, 1.83; P = 0.032). Adjusted for the quality of conversations, there was no significant difference. Conclusions Videos as stand-alone tools do not engage individuals in high-quality ACP. Pragmatic trials are necessary to evaluate their impact on downstream outcomes when integrated into intentional, comprehensive conversations with a health care provider. Considering the strong correlation between 2 activities (physicians discussing options, patients telling health care providers preferences), policy should focus on empowering patients to initiate these conversations.

Effect of a Video-Supported Nurse-Led Advance Care Planning for Older Adults with Frailty: A Randomized Controlled Trial

“…Despite high acceptable levels of satisfaction with the received treatment in both groups, the low median in QoC-EOL scores in this study reflected that the promotional leaflet alone in the control group and the stand-alone two-session ACP intervention in the intervention group might not be sufficient to improve the quality of the communication. A recent RCT also showed that video-alone intervention does not engage individuals in high-quality ACP [38]. The communication on EOL care was determined to be of low quality in this study because of the rareness of its occurrence.…”

“…A lack of communication on EOL care between healthcare professionals and older adults with frailty seems to be a worldwide problem. On-going discussions and deliberation with a healthcare provider in promoting patient-physician communication on EOL care are necessary [38].…”

What is the evidence for efficacy of advance care planning in improving patient outcomes? A systematic review of randomised controlled trials

“…Quality of patient–physician communication: Of the 19 RCTs assessing quality of communication,24 30 37 38 48 53 55 58–69 13 (68%) showed significant improvement in the outcome 24 30 37 38 48 53 58–64. Seven of these were deemed high-quality 24 37 53 58 59 61 64.…”

Advance Care Planning Among Elderly Acquired Immunodeficiency Syndrome Patients

“…Generally, ACP is more prevalent in developed countries, such as North America, Australia, and New Zealand, 15-18 and more widely accepted in the medical field, particularly in hospitals, communities, and nursing homes 11,15,19 . In addition to elderly patients, the ACP population comprises parents/guardians of minors with life-threatening illnesses, with the community being extended to patients with malignant tumors, Alzheimer disease, cardiovascular, and other diseases 7,19-21 . Despite the highlighted benefits of ACP in these disease states, little research has been done on the implementation of ACP by elderly AIDS patients in China.…”

“…11,15,19 In addition to elderly patients, the ACP population comprises parents/guardians of minors with lifethreatening illnesses, with the community being extended to patients with malignant tumors, Alzheimer disease, cardiovascular, and other diseases. 7,[19][20][21] Despite the highlighted benefits of ACP in these disease states, little research has been done on the implementation of ACP by elderly AIDS patients in China.…”