title: Randomized, Controlled Trial of an Advance Care Planning Video Decision Support Tool for Patients With Advanced Heart Failure.
abstract: Conversations about goals of care and cardiopulmonary resuscitation (CPR)/intubation for patients with advanced heart failure can be difficult. This study examined the impact of a video decision support tool and patient checklist on advance care planning for patients with heart failure.
  
  
  
  This was a multisite, randomized, controlled trial of a video-assisted intervention and advance care planning checklist versus a verbal description in 246 patients ≥64 years of age with heart failure and an estimated likelihood of death of >50% within 2 years. Intervention participants received a verbal description for goals of care (life-prolonging care, limited care, and comfort care) and CPR/intubation plus a 6-minute video depicting the 3 levels of care, CPR/intubation, and an advance care planning checklist. Control subjects received only the verbal description. The primary analysis compared the proportion of patients preferring comfort care between study arms immediately after the intervention. Secondary outcomes were CPR/intubation preferences and knowledge (6-item test; range, 0-6) after intervention.
  
  
  
  In the intervention group, 27 (22%) chose life-prolonging care, 31 (25%) chose limited care, 63 (51%) selected comfort care, and 2 (2%) were uncertain. In the control group, 50 (41%) chose life-prolonging care, 27 (22%) selected limited care, 37 (30%) chose comfort care, and 8 (7%) were uncertain (P<0.001). Intervention participants (compared with control subjects) were more likely to forgo CPR (68% versus 35%; P<0.001) and intubation (77% versus 48%; P<0.001) and had higher mean knowledge scores (4.1 versus 3.0; P<0.001).
  
  
  
  Patients with heart failure who viewed a video were more informed, more likely to select a focus on comfort, and less likely to desire CPR/intubation compared with patients receiving verbal information only.
  
  
  
  URL: http://www.clinicaltrials.gov. Unique identifier: NCT01589120.
authors.affiliation: From Massachusetts General Hospital, Boston (A.E.-J., M.S., Y.C., K.P., E.S.W.-C., J.S.T., E.M., A.E.V.); Harvard Medical School, Boston, MA (A.E.-J., L.S., E.F.L., G.S., M.S., Y.C., K.P., E.S.W.-C., J.S.T., A.E.V.); Boston University School of Medicine, MA (M.K.P.-O.); University of Colorado School of Medicine, Aurora (D.M.); Brigham and Women's Hospital, Boston, MA (L.S., E.F.L., G.S.); Newton-Wellesley Hospital, Newton, MA (H.B.); Tufts University School of Medicine, Boston, MA (H.B.); Vanderbilt University Medical Center, Nashville, TN (H.O.); and Nashville Veterans Administration Medical Center, TN (H.O.). ael-jawahri@partners.org.
authors.forename: Areej
authors.initials: A
authors.lastname: El-Jawahri
authors.affiliation: From Massachusetts General Hospital, Boston (A.E.-J., M.S., Y.C., K.P., E.S.W.-C., J.S.T., E.M., A.E.V.); Harvard Medical School, Boston, MA (A.E.-J., L.S., E.F.L., G.S., M.S., Y.C., K.P., E.S.W.-C., J.S.T., A.E.V.); Boston University School of Medicine, MA (M.K.P.-O.); University of Colorado School of Medicine, Aurora (D.M.); Brigham and Women's Hospital, Boston, MA (L.S., E.F.L., G.S.); Newton-Wellesley Hospital, Newton, MA (H.B.); Tufts University School of Medicine, Boston, MA (H.B.); Vanderbilt University Medical Center, Nashville, TN (H.O.); and Nashville Veterans Administration Medical Center, TN (H.O.).
authors.forename: Michael K
authors.initials: MK
authors.lastname: Paasche-Orlow
authors.affiliation: From Massachusetts General Hospital, Boston (A.E.-J., M.S., Y.C., K.P., E.S.W.-C., J.S.T., E.M., A.E.V.); Harvard Medical School, Boston, MA (A.E.-J., L.S., E.F.L., G.S., M.S., Y.C., K.P., E.S.W.-C., J.S.T., A.E.V.); Boston University School of Medicine, MA (M.K.P.-O.); University of Colorado School of Medicine, Aurora (D.M.); Brigham and Women's Hospital, Boston, MA (L.S., E.F.L., G.S.); Newton-Wellesley Hospital, Newton, MA (H.B.); Tufts University School of Medicine, Boston, MA (H.B.); Vanderbilt University Medical Center, Nashville, TN (H.O.); and Nashville Veterans Administration Medical Center, TN (H.O.).
authors.forename: Dan
authors.initials: D
authors.lastname: Matlock
authors.affiliation: From Massachusetts General Hospital, Boston (A.E.-J., M.S., Y.C., K.P., E.S.W.-C., J.S.T., E.M., A.E.V.); Harvard Medical School, Boston, MA (A.E.-J., L.S., E.F.L., G.S., M.S., Y.C., K.P., E.S.W.-C., J.S.T., A.E.V.); Boston University School of Medicine, MA (M.K.P.-O.); University of Colorado School of Medicine, Aurora (D.M.); Brigham and Women's Hospital, Boston, MA (L.S., E.F.L., G.S.); Newton-Wellesley Hospital, Newton, MA (H.B.); Tufts University School of Medicine, Boston, MA (H.B.); Vanderbilt University Medical Center, Nashville, TN (H.O.); and Nashville Veterans Administration Medical Center, TN (H.O.).
authors.forename: Lynne Warner
authors.initials: LW
authors.lastname: Stevenson
authors.affiliation: From Massachusetts General Hospital, Boston (A.E.-J., M.S., Y.C., K.P., E.S.W.-C., J.S.T., E.M., A.E.V.); Harvard Medical School, Boston, MA (A.E.-J., L.S., E.F.L., G.S., M.S., Y.C., K.P., E.S.W.-C., J.S.T., A.E.V.); Boston University School of Medicine, MA (M.K.P.-O.); University of Colorado School of Medicine, Aurora (D.M.); Brigham and Women's Hospital, Boston, MA (L.S., E.F.L., G.S.); Newton-Wellesley Hospital, Newton, MA (H.B.); Tufts University School of Medicine, Boston, MA (H.B.); Vanderbilt University Medical Center, Nashville, TN (H.O.); and Nashville Veterans Administration Medical Center, TN (H.O.).
authors.forename: Eldrin F
authors.initials: EF
authors.lastname: Lewis
authors.affiliation: From Massachusetts General Hospital, Boston (A.E.-J., M.S., Y.C., K.P., E.S.W.-C., J.S.T., E.M., A.E.V.); Harvard Medical School, Boston, MA (A.E.-J., L.S., E.F.L., G.S., M.S., Y.C., K.P., E.S.W.-C., J.S.T., A.E.V.); Boston University School of Medicine, MA (M.K.P.-O.); University of Colorado School of Medicine, Aurora (D.M.); Brigham and Women's Hospital, Boston, MA (L.S., E.F.L., G.S.); Newton-Wellesley Hospital, Newton, MA (H.B.); Tufts University School of Medicine, Boston, MA (H.B.); Vanderbilt University Medical Center, Nashville, TN (H.O.); and Nashville Veterans Administration Medical Center, TN (H.O.).
authors.forename: Garrick
authors.initials: G
authors.lastname: Stewart
authors.affiliation: From Massachusetts General Hospital, Boston (A.E.-J., M.S., Y.C., K.P., E.S.W.-C., J.S.T., E.M., A.E.V.); Harvard Medical School, Boston, MA (A.E.-J., L.S., E.F.L., G.S., M.S., Y.C., K.P., E.S.W.-C., J.S.T., A.E.V.); Boston University School of Medicine, MA (M.K.P.-O.); University of Colorado School of Medicine, Aurora (D.M.); Brigham and Women's Hospital, Boston, MA (L.S., E.F.L., G.S.); Newton-Wellesley Hospital, Newton, MA (H.B.); Tufts University School of Medicine, Boston, MA (H.B.); Vanderbilt University Medical Center, Nashville, TN (H.O.); and Nashville Veterans Administration Medical Center, TN (H.O.).
authors.forename: Marc
authors.initials: M
authors.lastname: Semigran
authors.affiliation: From Massachusetts General Hospital, Boston (A.E.-J., M.S., Y.C., K.P., E.S.W.-C., J.S.T., E.M., A.E.V.); Harvard Medical School, Boston, MA (A.E.-J., L.S., E.F.L., G.S., M.S., Y.C., K.P., E.S.W.-C., J.S.T., A.E.V.); Boston University School of Medicine, MA (M.K.P.-O.); University of Colorado School of Medicine, Aurora (D.M.); Brigham and Women's Hospital, Boston, MA (L.S., E.F.L., G.S.); Newton-Wellesley Hospital, Newton, MA (H.B.); Tufts University School of Medicine, Boston, MA (H.B.); Vanderbilt University Medical Center, Nashville, TN (H.O.); and Nashville Veterans Administration Medical Center, TN (H.O.).
authors.forename: Yuchiao
authors.initials: Y
authors.lastname: Chang
authors.affiliation: From Massachusetts General Hospital, Boston (A.E.-J., M.S., Y.C., K.P., E.S.W.-C., J.S.T., E.M., A.E.V.); Harvard Medical School, Boston, MA (A.E.-J., L.S., E.F.L., G.S., M.S., Y.C., K.P., E.S.W.-C., J.S.T., A.E.V.); Boston University School of Medicine, MA (M.K.P.-O.); University of Colorado School of Medicine, Aurora (D.M.); Brigham and Women's Hospital, Boston, MA (L.S., E.F.L., G.S.); Newton-Wellesley Hospital, Newton, MA (H.B.); Tufts University School of Medicine, Boston, MA (H.B.); Vanderbilt University Medical Center, Nashville, TN (H.O.); and Nashville Veterans Administration Medical Center, TN (H.O.).
authors.forename: Kimberly
authors.initials: K
authors.lastname: Parks
authors.affiliation: From Massachusetts General Hospital, Boston (A.E.-J., M.S., Y.C., K.P., E.S.W.-C., J.S.T., E.M., A.E.V.); Harvard Medical School, Boston, MA (A.E.-J., L.S., E.F.L., G.S., M.S., Y.C., K.P., E.S.W.-C., J.S.T., A.E.V.); Boston University School of Medicine, MA (M.K.P.-O.); University of Colorado School of Medicine, Aurora (D.M.); Brigham and Women's Hospital, Boston, MA (L.S., E.F.L., G.S.); Newton-Wellesley Hospital, Newton, MA (H.B.); Tufts University School of Medicine, Boston, MA (H.B.); Vanderbilt University Medical Center, Nashville, TN (H.O.); and Nashville Veterans Administration Medical Center, TN (H.O.).
authors.forename: Elizabeth S
authors.initials: ES
authors.lastname: Walker-Corkery
authors.affiliation: From Massachusetts General Hospital, Boston (A.E.-J., M.S., Y.C., K.P., E.S.W.-C., J.S.T., E.M., A.E.V.); Harvard Medical School, Boston, MA (A.E.-J., L.S., E.F.L., G.S., M.S., Y.C., K.P., E.S.W.-C., J.S.T., A.E.V.); Boston University School of Medicine, MA (M.K.P.-O.); University of Colorado School of Medicine, Aurora (D.M.); Brigham and Women's Hospital, Boston, MA (L.S., E.F.L., G.S.); Newton-Wellesley Hospital, Newton, MA (H.B.); Tufts University School of Medicine, Boston, MA (H.B.); Vanderbilt University Medical Center, Nashville, TN (H.O.); and Nashville Veterans Administration Medical Center, TN (H.O.).
authors.forename: Jennifer S
authors.initials: JS
authors.lastname: Temel
authors.affiliation: From Massachusetts General Hospital, Boston (A.E.-J., M.S., Y.C., K.P., E.S.W.-C., J.S.T., E.M., A.E.V.); Harvard Medical School, Boston, MA (A.E.-J., L.S., E.F.L., G.S., M.S., Y.C., K.P., E.S.W.-C., J.S.T., A.E.V.); Boston University School of Medicine, MA (M.K.P.-O.); University of Colorado School of Medicine, Aurora (D.M.); Brigham and Women's Hospital, Boston, MA (L.S., E.F.L., G.S.); Newton-Wellesley Hospital, Newton, MA (H.B.); Tufts University School of Medicine, Boston, MA (H.B.); Vanderbilt University Medical Center, Nashville, TN (H.O.); and Nashville Veterans Administration Medical Center, TN (H.O.).
authors.forename: Hacho
authors.initials: H
authors.lastname: Bohossian
authors.affiliation: From Massachusetts General Hospital, Boston (A.E.-J., M.S., Y.C., K.P., E.S.W.-C., J.S.T., E.M., A.E.V.); Harvard Medical School, Boston, MA (A.E.-J., L.S., E.F.L., G.S., M.S., Y.C., K.P., E.S.W.-C., J.S.T., A.E.V.); Boston University School of Medicine, MA (M.K.P.-O.); University of Colorado School of Medicine, Aurora (D.M.); Brigham and Women's Hospital, Boston, MA (L.S., E.F.L., G.S.); Newton-Wellesley Hospital, Newton, MA (H.B.); Tufts University School of Medicine, Boston, MA (H.B.); Vanderbilt University Medical Center, Nashville, TN (H.O.); and Nashville Veterans Administration Medical Center, TN (H.O.).
authors.forename: Henry
authors.initials: H
authors.lastname: Ooi
authors.affiliation: From Massachusetts General Hospital, Boston (A.E.-J., M.S., Y.C., K.P., E.S.W.-C., J.S.T., E.M., A.E.V.); Harvard Medical School, Boston, MA (A.E.-J., L.S., E.F.L., G.S., M.S., Y.C., K.P., E.S.W.-C., J.S.T., A.E.V.); Boston University School of Medicine, MA (M.K.P.-O.); University of Colorado School of Medicine, Aurora (D.M.); Brigham and Women's Hospital, Boston, MA (L.S., E.F.L., G.S.); Newton-Wellesley Hospital, Newton, MA (H.B.); Tufts University School of Medicine, Boston, MA (H.B.); Vanderbilt University Medical Center, Nashville, TN (H.O.); and Nashville Veterans Administration Medical Center, TN (H.O.).
authors.forename: Eileen
authors.initials: E
authors.lastname: Mann
authors.affiliation: From Massachusetts General Hospital, Boston (A.E.-J., M.S., Y.C., K.P., E.S.W.-C., J.S.T., E.M., A.E.V.); Harvard Medical School, Boston, MA (A.E.-J., L.S., E.F.L., G.S., M.S., Y.C., K.P., E.S.W.-C., J.S.T., A.E.V.); Boston University School of Medicine, MA (M.K.P.-O.); University of Colorado School of Medicine, Aurora (D.M.); Brigham and Women's Hospital, Boston, MA (L.S., E.F.L., G.S.); Newton-Wellesley Hospital, Newton, MA (H.B.); Tufts University School of Medicine, Boston, MA (H.B.); Vanderbilt University Medical Center, Nashville, TN (H.O.); and Nashville Veterans Administration Medical Center, TN (H.O.).
authors.forename: Angelo E
authors.initials: AE
authors.lastname: Volandes
mesh_terms: D032722:Advance Care Planning; D000368:Aged; D000369:Aged, 80 and over; D016887:Cardiopulmonary Resuscitation / Q000523:psychology; D057189:Checklist; D003661:Decision Support Techniques; D006333:Heart Failure / Q000523:psychology / Q000628:therapy*; D006784:Hospitals, Teaching; D006801:Humans; D007442:Intubation, Intratracheal / Q000523:psychology; D008875:Middle Aged; D010342:Patient Acceptance of Health Care; D010353:Patient Education as Topic / Q000379:methods*; D057240:Patient Preference; D012121:Respiration, Artificial / Q000523:psychology; D013727:Terminal Care / Q000379:methods / Q000523:psychology; D014743:Videotape Recording
keywords: heart failure; quality of health care; quality of life