title: Video decision aids to assist with advance care planning: a systematic review and meta-analysis.
abstract: OBJECTIVE
  Advance care planning (ACP) can result in end-of-life care that is more congruent with patients' values and preferences. There is increasing interest in video decision aids to assist with ACP. The objective of this study was to evaluate the impact of video decision aids on patients' preferences regarding life-sustaining treatments (primary outcome).
  
  
  METHODS
  Systematic review and meta-analysis of randomised controlled trials.
  
  
  METHODS
  MEDLINE, EMBASE, PsycInfo, CINAHL, AMED and CENTRAL, between 1980 and February 2014, and correspondence with authors.
  
  
  METHODS
  Randomised controlled trials of adult patients that compared a video decision aid to a non-video-based intervention to assist with choices about use of life-sustaining treatments and reported at least one ACP-related outcome.
  
  
  METHODS
  Reviewers worked independently and in pairs to screen potentially eligible articles, and to extract data regarding risk of bias, population, intervention, comparator and outcomes. Reviewers assessed quality of evidence (confidence in effect estimates) for each outcome using the Grading of Recommendations Assessment, Development and Evaluation framework.
  
  
  RESULTS
  10 trials enrolling 2220 patients were included. Low-quality evidence suggests that patients who use a video decision aid are less likely to indicate a preference for cardiopulmonary resuscitation (pooled risk ratio, 0.50 (95% CI 0.27 to 0.95); I(2)=65%). Moderate-quality evidence suggests that video decision aids result in greater knowledge related to ACP (standardised mean difference, 0.58 (95% CI 0.38 to 0.77); I(2)=0%). No study reported on the congruence of end-of-life treatments with patients' wishes. No study evaluated the effect of video decision aids when integrated into clinical care.
  
  
  CONCLUSIONS
  Video decision aids may improve some ACP-related outcomes. Before recommending their use in clinical practice, more evidence is needed to confirm these findings and to evaluate the impact of video decision aids when integrated into patient care.
authors.affiliation: Department of Family and Community Medicine, University of Toronto, Toronto, Ontario, Canada.
authors.forename: Ashu
authors.initials: A
authors.lastname: Jain
authors.affiliation: Division of Respirology, Department of Medicine, McMaster University, Hamilton, Ontario, Canada.
authors.forename: Sophie
authors.initials: S
authors.lastname: Corriveau
authors.affiliation: Department of Medicine, McMaster University, Hamilton, Ontario, Canada.
authors.forename: Kathleen
authors.initials: K
authors.lastname: Quinn
authors.affiliation: Division of Geriatric Medicine, Department of Medicine, University of Toronto, Toronto, Ontario, Canada.
authors.forename: Amanda
authors.initials: A
authors.lastname: Gardhouse
authors.affiliation: Division of General Internal Medicine, Department of Medicine, McMaster University, St Joseph's Healthcare, Hamilton, Ontario, Canada.
authors.forename: Daniel Brandt
authors.initials: DB
authors.lastname: Vegas
authors.affiliation: Departments of Medicine, and Clinical Epidemiology & Biostatistics, McMaster University, Hamilton, Ontario, Canada.
authors.forename: John J
authors.initials: JJ
authors.lastname: You
mesh_terms: D032722:Advance Care Planning; D016223:Advance Directives; D000368:Aged; D000369:Aged, 80 and over; D016887:Cardiopulmonary Resuscitation / Q000379:methods; D003422:Critical Care; D003661:Decision Support Techniques; D007722:Health Knowledge, Attitudes, Practice; D006801:Humans; D008875:Middle Aged; D010358:Patient Participation; D057240:Patient Preference; D016032:Randomized Controlled Trials as Topic; D014741:Video Recording
keywords: advance care planning; shared decision making; systematic review; video