title: Augmenting advance care planning in poor prognosis cancer with a video decision aid: a preintervention-postintervention study.
abstract: BACKGROUND
  The authors tested whether an educational video on the goals of care in advanced cancer (life-prolonging care, basic care, or comfort care) helped patients understand these goals and had an impact on their preferences for resuscitation.
  
  
  METHODS
  A survey of 80 patients with advanced cancer was conducted before and after they viewed an educational video. The outcomes of interest included changes in goals of care preference and knowledge and consistency of preferences with code status.
  
  
  RESULTS
  Before viewing the video, 10 patients (13%) preferred life-prolonging care, 24 patients (30%) preferred basic care, 29 patients (36%) preferred comfort care, and 17 patients (21%) were unsure. Preferences did not change after the video, when 9 patients (11%) chose life-prolonging care, 28 patients (35%) chose basic care, 29 patients (36%) chose comfort care, and, 14 patients (18%) were unsure (P = .28). Compared with baseline, after the video presentation, more patients did not want cardiopulmonary resuscitation (CPR) (71% vs 62%; P = .03) or ventilation (80% vs 67%; P = .008). Knowledge about goals of care and likelihood of resuscitation increased after the video (P < .001). Of the patients who did not want CPR or ventilation after the video augmentation, only 4 patients (5%) had a documented do-not-resuscitate order in their medical record (kappa statistic, -0.01; 95% confidence interval, -0.06 to 0.04). Acceptability of the video was high.
  
  
  CONCLUSIONS
  Patients with advanced cancer did not change care preferences after viewing the video, but fewer wanted CPR or ventilation. Documented code status was inconsistent with patient preferences. Patients were more knowledgeable after the video, reported that the video was acceptable, and said they would recommend it to others. The current results indicated that this type of video may enable patients to visualize "goals of care," enriching patient understanding of worsening health states and better informing decision making.
authors.affiliation: General Medicine Unit, Department of Medicine, Massachusetts General Hospital and Harvard Medical School, Boston, Massachusetts, USA. avolandes@partners.org
authors.forename: Angelo E
authors.initials: AE
authors.lastname: Volandes
authors.forename: Tomer T
authors.initials: TT
authors.lastname: Levin
authors.forename: Susan
authors.initials: S
authors.lastname: Slovin
authors.forename: Richard D
authors.initials: RD
authors.lastname: Carvajal
authors.forename: Eileen M
authors.initials: EM
authors.lastname: O'Reilly
authors.forename: Mary Louise
authors.initials: ML
authors.lastname: Keohan
authors.forename: Maria
authors.initials: M
authors.lastname: Theodoulou
authors.forename: Maura
authors.initials: M
authors.lastname: Dickler
authors.forename: John F
authors.initials: JF
authors.lastname: Gerecitano
authors.forename: Michael
authors.initials: M
authors.lastname: Morris
authors.forename: Andrew S
authors.initials: AS
authors.lastname: Epstein
authors.forename: Anastazia
authors.initials: A
authors.lastname: Naka-Blackstone
authors.forename: Elizabeth S
authors.initials: ES
authors.lastname: Walker-Corkery
authors.forename: Yuchiao
authors.initials: Y
authors.lastname: Chang
authors.forename: Ariela
authors.initials: A
authors.lastname: Noy
mesh_terms: D000328:Adult; D032722:Advance Care Planning; D000368:Aged; D000369:Aged, 80 and over; D003657:Decision Making; D003661:Decision Support Techniques; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D009369:Neoplasms / Q000628:therapy*; D017060:Patient Satisfaction; D011379:Prognosis; D014743:Videotape Recording