Seeing video firms up end-of-life care decisions

  1. Seeing video firms up end-of-life care decisions

    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 and his colleagues found.

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

    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 percent said they would choose comfort care, compared with 86 percent of those who saw the video.

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

    When the researchers contacted the study participants again six weeks later, they found that 29 percent of people in the description-only group had changed their mind about their care preferences, compared to 6 percent of people who saw the video.
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  3. by   pers
    That's really interesting, shame they didn't provide the video.

    Wish someone would work on something similar to use in education regarding DNR status.
  4. by   tlesh
    So true! I work in the ICU and I would love for them to show a video of us running a full code before they allow us to do it to them or their family members. When we bring family members in, and they see how traumatizing they are, if the patient is older they family often requests us to stop. I wish families and patients were more educated about what really happens during "codes".
  5. by   Lorie P.
    I wish people were educated on end-of-life care, death and the natural process, exactly what a CODE is like...It sure would help!
    Last edit by Lorie P. on Jun 4, '09 : Reason: type o
  6. by   elprup
    Actually this has been copyrighted/trademarked (whatever one has to do) and is being put into work as we speak by a friend of mine who is really excited about it. Once it gets going, which should be soon, i'll provide the website for everybody!
  7. by   jjdennis1279
    This is an interesting article with potentially significant implications. Before videos, as opposed to narrative descriptions, are used to influence patients' decisions, I believe it would be important to evaluate how the disease state or medical procedure is portrayed. I imagine it would be possible to present anything with a biased spin. With that in mind, how does one know the video used in this article presents an accurate portrayal of dementia?