Using Video Images of Dementia in Advance Care Planning

Abstract

Background: Advance care planning is a process by which patients plan for future medical care under circumstances of impaired decision-making. Central to this process is the patient's understanding and ability to imagine future health states. Methods: A before and after oral survey was used to compare the effect of a video depiction with that of a verbal description of a patient with advanced dementia for individuals selecting level of medical care at 7 primary care clinics at 2 US medical centers. The study enrolled 120 adults, half of whom were nonwhite. Results: A total of 120 subjects completed the interview. Before watching the video, 60 (50.0%) subjects preferred comfort care, 25 (20.8%) desired life-prolonging care, 22 (18.3%) chose limited care, and 13 (10.8%) were unsure of their preferences. Subject preferences changed significantly after the video: 107 (89.2%) of the subjects chose comfort care, none desired life-prolonging care, 10

Affective Forecasting: An Unrecognized Challenge in Making Serious Health Decisions

“…A recent study showed that while 20% of participants said that they desired lifeprolonging treatment if they had advanced Alzheimer's disease, after seeing a video of a patient and family's struggles, not one desired life-prolonging treatment. 61 Thus, the powerful impact of narratives might call for giving patients a time gap or debriefing between experiencing them and making their decisions.…”

Update in Palliative Care - 2011

“…19 Video images have been shown to improve the communication of health information and the description of health states. [20][21][22][23][24] What This Study Adds…”

Augmenting Communication and Decision Making in the Intensive Care Unit with a Cardiopulmonary Resuscitation Video Decision Support Tool: A Temporal Intervention Study

“…The questionnaire was adapted from prior studies. [11][12][13][14][15] The baseline assessment included age, sex, self-reported race and ethnicity, religion and intensity of religious practice, educational status, and marital status. Surrogates provided this information for themselves and for the patient and indicated whether the patient had engaged in prior conversations about goals of therapy and/or had completed any advance directives (either identified a health care proxy and/or drafted a living will).…”

“…1B). [11][12][13][14][15] Overall scores ranged from 0 to 4, with higher scores representing more knowledge of the choices of medical care. Surrogates in the post-intervention arm of our study viewed the CPR video decision support tool before answering the knowledge questions.…”

“…For example, among patients with cancer and dementia, when compared to verbal communication alone, patients who viewed videos were more knowledgeable about their options, more certain of their decisions, and more likely to avoid life-prolonging interventions if the predicted success rate were low. [11][12][13][14][15] To the best of our knowledge, video decision support tools have not been introduced to the critical care setting to improve communication and better inform decision making.…”