title: Augmenting communication and decision making in the intensive care unit with a cardiopulmonary resuscitation video decision support tool: a temporal intervention study.
abstract: OBJECTIVE
  Effective communication between intensive care unit (ICU) providers and families is crucial given the complexity of decisions made regarding goals of therapy. Using video images to supplement medical discussions is an innovative process to standardize and improve communication. In this six-month, quasi-experimental, pre-post intervention study we investigated the impact of a cardiopulmonary resuscitation (CPR) video decision support tool upon knowledge about CPR among surrogate decision makers for critically ill adults.
  
  
  METHODS
  We interviewed surrogate decision makers for patients aged 50 and over, using a structured questionnaire that included a four-question CPR knowledge assessment similar to those used in previous studies. Surrogates in the post-intervention arm viewed a three-minute video decision support tool about CPR before completing the knowledge assessment and completed questions about perceived value of the video.
  
  
  RESULTS
  We recruited 23 surrogates during the first three months (pre-intervention arm) and 27 surrogates during the latter three months of the study (post-intervention arm). Surrogates viewing the video had more knowledge about CPR (p=0.008); average scores were 2.0 (SD 1.1) and 2.9 (SD 1.2) (out of a total of 4) in pre-intervention and post-intervention arms. Surrogates who viewed the video were comfortable with its content (81% very) and 81% would recommend the video. CPR preferences for patients at the time of ICU discharge/death were distributed as follows: pre-intervention: full code 78%, DNR 22%; post-intervention: full code 59%, DNR 41% (p=0.23).
authors.affiliation: Harvard Medical School, Boston, Massachusetts, USA.
authors.forename: Jessica B
authors.initials: JB
authors.lastname: McCannon
authors.forename: Walter J
authors.initials: WJ
authors.lastname: O'Donnell
authors.forename: B Taylor
authors.initials: BT
authors.lastname: Thompson
authors.forename: Areej
authors.initials: A
authors.lastname: El-Jawahri
authors.forename: Yuchiao
authors.initials: Y
authors.lastname: Chang
authors.forename: Lillian
authors.initials: L
authors.lastname: Ananian
authors.forename: Ednan K
authors.initials: EK
authors.lastname: Bajwa
authors.forename: Paul F
authors.initials: PF
authors.lastname: Currier
authors.forename: Mihir
authors.initials: M
authors.lastname: Parikh
authors.forename: Jennifer S
authors.initials: JS
authors.lastname: Temel
authors.forename: Zara
authors.initials: Z
authors.lastname: Cooper
authors.forename: Renda Soylemez
authors.initials: RS
authors.lastname: Wiener
authors.forename: Angelo E
authors.initials: AE
authors.lastname: Volandes
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D016887:Cardiopulmonary Resuscitation; D003142:Communication; D016001:Confidence Intervals; D003657:Decision Making; D020000:Decision Support Systems, Clinical; D005260:Female; D007722:Health Knowledge, Attitudes, Practice; D006801:Humans; D007362:Intensive Care Units; D008297:Male; D008875:Middle Aged; D019727:Proxy / Q000523:psychology; D036301:Qualitative Research