title: Why don't end-of-life conversations go viral? A review of videos on YouTube.
abstract: OBJECTIVE
  To identify videos on YouTube concerning advance care planning (ACP) and synthesise existing video content and style elements.
  
  
  METHODS
  Informed by stakeholder engagement, two researchers searched YouTube for ACP videos using predefined search terms and snowballing techniques. Videos identified were reviewed and deemed ineligible for analysis if they: targeted healthcare professionals; contained irrelevant content; focused on viewers under the age of 18; were longer than 7 min in duration; received fewer than 150 views; were in a language other than English; or were a duplicate version. For each video, two investigators independently extracted general information as well as video content and stylistic characteristics.
  
  
  RESULTS
  The YouTube search identified 23 100 videos with 213 retrieved for assessment and 42 meeting eligibility criteria. The majority of videos had been posted to YouTube since 2010 and produced by organisations in the USA (71%). Viewership ranged from 171 to 10 642. Most videos used a documentary style and featured healthcare providers (60%) rather than patients (19%) or families (45%). A minority of videos (29%) used upbeat or hopeful music. The videos frequently focused on completing legal medical documents (86%).
  
  
  CONCLUSIONS
  None of the ACP videos on YouTube went viral and a relatively small number of them contained elements endorsed by stakeholders. In emphasising the completion of legal medical documents, videos may have failed to support more meaningful ACP. Further research is needed to understand the features of videos that will engage patients and the wider community with ACP and palliative and end-of-life care conversations.
authors.affiliation: The Commonwealth Fund, Boston, Massachusetts, USA.|Department of Health Policy and Management, Johns Hopkins Bloomberg School of Public Health, Baltimore, Massachusetts, USA.
authors.forename: Imogen A
authors.initials: IA
authors.lastname: Mitchell
authors.affiliation: Department of Health Policy and Management, Johns Hopkins Bloomberg School of Public Health, Baltimore, Massachusetts, USA.
authors.forename: Anne L R
authors.initials: ALR
authors.lastname: Schuster
authors.affiliation: Department of Anesthesiology and Critical Care Medicine and Palliative Care Program, Johns Hopkins Hospital, Baltimore, Massachusetts, USA.
authors.forename: Thomas
authors.initials: T
authors.lastname: Lynch
authors.affiliation: Department of Health, Behavior and Society, Johns Hopkins Bloomberg School of Public Health, Baltimore, Massachusetts, USA.
authors.forename: Katherine Clegg
authors.initials: KC
authors.lastname: Smith
authors.affiliation: Department of Health Policy and Management, Johns Hopkins Bloomberg School of Public Health, Baltimore, Massachusetts, USA.
authors.forename: John F P
authors.initials: JFP
authors.lastname: Bridges
authors.affiliation: Department of Anesthesiology and Critical Care Medicine and Palliative Care Program, Johns Hopkins Hospital, Baltimore, Massachusetts, USA.
authors.forename: Rebecca A
authors.initials: RA
authors.lastname: Aslakson
mesh_terms: D032722:Advance Care Planning; D006801:Humans; D020407:Internet; D014741:Video Recording
keywords: Clinical decisions; Communication; Terminal care