title: Randomized controlled trial of a video decision support tool for cardiopulmonary resuscitation decision making in advanced cancer.
abstract: OBJECTIVE
  Decision making regarding cardiopulmonary resuscitation (CPR) is challenging. This study examined the effect of a video decision support tool on CPR preferences among patients with advanced cancer.
  
  
  METHODS
  We performed a randomized controlled trial of 150 patients with advanced cancer from four oncology centers. Participants in the control arm (n = 80) listened to a verbal narrative describing CPR and the likelihood of successful resuscitation. Participants in the intervention arm (n = 70) listened to the identical narrative and viewed a 3-minute video depicting a patient on a ventilator and CPR being performed on a simulated patient. The primary outcome was participants' preference for or against CPR measured immediately after exposure to either modality. Secondary outcomes were participants' knowledge of CPR (score range of 0 to 4, with higher score indicating more knowledge) and comfort with video.
  
  
  RESULTS
  The mean age of participants was 62 years (standard deviation, 11 years); 49% were women, 44% were African American or Latino, and 47% had lung or colon cancer. After the verbal narrative, in the control arm, 38 participants (48%) wanted CPR, 41 (51%) wanted no CPR, and one (1%) was uncertain. In contrast, in the intervention arm, 14 participants (20%) wanted CPR, 55 (79%) wanted no CPR, and 1 (1%) was uncertain (unadjusted odds ratio, 3.5; 95% CI, 1.7 to 7.2; P < .001). Mean knowledge scores were higher in the intervention arm than in the control arm (3.3 ± 1.0 v 2.6 ± 1.3, respectively; P < .001), and 65 participants (93%) in the intervention arm were comfortable watching the video.
  
  
  CONCLUSIONS
  Participants with advanced cancer who viewed a video of CPR were less likely to opt for CPR than those who listened to a verbal narrative.
authors.affiliation: Massachusetts General Hospital, General Medicine Unit, 50 Staniford St, 9th Floor, Boston, MA 02114, USA. avolandes@partners.org
authors.forename: Angelo E
authors.initials: AE
authors.lastname: Volandes
authors.forename: Michael K
authors.initials: MK
authors.lastname: Paasche-Orlow
authors.forename: Susan L
authors.initials: SL
authors.lastname: Mitchell
authors.forename: Areej
authors.initials: A
authors.lastname: El-Jawahri
authors.forename: Aretha Delight
authors.initials: AD
authors.lastname: Davis
authors.forename: Michael J
authors.initials: MJ
authors.lastname: Barry
authors.forename: Kevan L
authors.initials: KL
authors.lastname: Hartshorn
authors.forename: Vicki Ann
authors.initials: VA
authors.lastname: Jackson
authors.forename: Muriel R
authors.initials: MR
authors.lastname: Gillick
authors.forename: Elizabeth S
authors.initials: ES
authors.lastname: Walker-Corkery
authors.forename: Yuchiao
authors.initials: Y
authors.lastname: Chang
authors.forename: Lenny
authors.initials: L
authors.lastname: López
authors.forename: Margaret
authors.initials: M
authors.lastname: Kemeny
authors.forename: Linda
authors.initials: L
authors.lastname: Bulone
authors.forename: Eileen
authors.initials: E
authors.lastname: Mann
authors.forename: Sumi
authors.initials: S
authors.lastname: Misra
authors.forename: Matt
authors.initials: M
authors.lastname: Peachey
authors.forename: Elmer D
authors.initials: ED
authors.lastname: Abbo
authors.forename: April F
authors.initials: AF
authors.lastname: Eichler
authors.forename: Andrew S
authors.initials: AS
authors.lastname: Epstein
authors.forename: Ariela
authors.initials: A
authors.lastname: Noy
authors.forename: Tomer T
authors.initials: TT
authors.lastname: Levin
authors.forename: Jennifer S
authors.initials: JS
authors.lastname: Temel
mesh_terms: D016887:Cardiopulmonary Resuscitation; D003657:Decision Making; D005260:Female; D006801:Humans; D008297:Male; D009369:Neoplasms / Q000150:complications / Q000523:psychology*; D057240:Patient Preference / Q000523:psychology*; D013727:Terminal Care / Q000379:methods*; D014743:Videotape Recording