title: A randomized controlled trial of a goals-of-care video for elderly patients admitted to skilled nursing facilities.
abstract: OBJECTIVE
  To determine the impact of a video on preferences for the primary goal of care.
  
  
  METHODS
  Consecutive subjects 65 years of age or older (n=101) admitted to two skilled nursing facilities (SNFs) were randomized to a verbal narrative (control) or a video (intervention) describing goals-of-care options. Options included: life-prolonging (i.e., cardiopulmonary resuscitation), limited (i.e., hospitalization but no cardiopulmonary resuscitation), or comfort care (i.e., symptom relief).
  
  
  METHODS
  Primary outcome was patients' preferences for comfort versus other options. Concordance of preferences with documentation in the medical record was also examined.
  
  
  RESULTS
  Fifty-one subjects were randomized to the verbal arm and 50 to the video arm. In the verbal arm, preferences were: comfort, n=29 (57%); limited, n=4 (8%); life-prolonging, n=17 (33%); and uncertain, n=1 (2%). In the video arm, preferences were: comfort, n=40 (80%); limited, n=4 (8%); and life-prolonging, n=6 (12%). Randomization to the video was associated with greater likelihood of opting for comfort (unadjusted rate ratio, 1.4; 95% confidence interval [CI], 1.1-1.9, p=0.02). Among subjects in the verbal arm who chose comfort, 29% had a do-not-resuscitate (DNR) order (κ statistic 0.18; 95% CI-0.02 to 0.37); 33% of subjects in the video arm choosing comfort had a DNR order (κ statistic 0.06; 95% CI-0.09 to 0.22).
  
  
  CONCLUSIONS
  Subjects admitted to SNFs who viewed a video were more likely than those exposed to a verbal narrative to opt for comfort. Concordance between a preference for comfort and a DNR order was low. These findings suggest a need to improve ascertainment of patients' preferences.
  
  
  BACKGROUND
  Clinicaltrials.gov Identifier: NCT01233973.
authors.affiliation: Harvard Medical School, Boston, MA 02114, USA. avolandes@partners.org
authors.forename: Angelo E
authors.initials: AE
authors.lastname: Volandes
authors.forename: Gary H
authors.initials: GH
authors.lastname: Brandeis
authors.forename: Aretha Delight
authors.initials: AD
authors.lastname: Davis
authors.forename: Michael K
authors.initials: MK
authors.lastname: Paasche-Orlow
authors.forename: Muriel R
authors.initials: MR
authors.lastname: Gillick
authors.forename: Yuchiao
authors.initials: Y
authors.lastname: Chang
authors.forename: Elizabeth S
authors.initials: ES
authors.lastname: Walker-Corkery
authors.forename: Eileen
authors.initials: E
authors.lastname: Mann
authors.forename: Susan L
authors.initials: SL
authors.lastname: Mitchell
mesh_terms: D000368:Aged; D001900:Boston; D005260:Female; D006040:Goals; D006801:Humans; D008297:Male; D057240:Patient Preference; D036301:Qualitative Research; D011787:Quality of Health Care; D012866:Skilled Nursing Facilities; D013727:Terminal Care; D014743:Videotape Recording