Augmenting advance care planning in poor prognosis cancer with a video decision aid Journal Article


Authors: Volandes, A. E.; Levin, T. T.; Slovin, S.; Carvajal, R. D.; O'Reilly, E. M.; Keohan, M. L.; Theodoulou, M.; Dickler, M.; Gerecitano, J. F.; Morris, M.; Epstein, A. S.; Naka Blackstone, A.; Walker Corkery, E. S.; Chang, Y.; Noy, A.
Article Title: Augmenting advance care planning in poor prognosis cancer with a video decision aid
Abstract: Background: The authors tested whether an educational video on the goals of care in advanced cancer (life-prolonging care, basic care, or comfort care) helped patients understand these goals and had an impact on their preferences for resuscitation. Methods: A survey of 80 patients with advanced cancer was conducted before and after they viewed an educational video. The outcomes of interest included changes in goals of care preference and knowledge and consistency of preferences with code status. Results: Before viewing the video, 10 patients (13%) preferred life-prolonging care, 24 patients (30%) preferred basic care, 29 patients (36%) preferred comfort care, and 17 patients (21%) were unsure. Preferences did not change after the video, when 9 patients (11%) chose life-prolonging care, 28 patients (35%) chose basic care, 29 patients (36%) chose comfort care, and, 14 patients (18%) were unsure (P =.28). Compared with baseline, after the video presentation, more patients did not want cardiopulmonary resuscitation (CPR) (71% vs 62%; P =.03) or ventilation (80% vs 67%; P =.008). Knowledge about goals of care and likelihood of resuscitation increased after the video (P <.001). Of the patients who did not want CPR or ventilation after the video augmentation, only 4 patients (5%) had a documented do-not-resuscitate order in their medical record (kappa statistic, -0.01; 95% confidence interval, -0.06 to 0.04). Acceptability of the video was high. Conclusions: Patients with advanced cancer did not change care preferences after viewing the video, but fewer wanted CPR or ventilation. Documented code status was inconsistent with patient preferences. Patients were more knowledgeable after the video, reported that the video was acceptable, and said they would recommend it to others. The current results indicated that this type of video may enable patients to visualize "goals of care," enriching patient understanding of worsening health states and better informing decision making. © 2011 American Cancer Society.
Keywords: adult; aged; major clinical study; advanced cancer; outcome assessment; health survey; videorecording; cancer therapy; patient care; medical information; medical record; information dissemination; clinical decision making; resuscitation; artificial ventilation; preferences; decision support system; patient preference; decision-making; advance care planning; cancer prognosis; code status; end-of-life decision-making; video decision aids; comfort care; life sustaining treatment
Journal Title: Cancer
Volume: 118
Issue: 17
ISSN: 0008-543X
Publisher: Wiley Blackwell  
Date Published: 2012-09-01
Start Page: 4331
End Page: 4338
Language: English
DOI: 10.1002/cncr.27423
PROVIDER: scopus
PMCID: PMC3359413
PUBMED: 22252775
DOI/URL:
Notes: --- - "Export Date: 1 October 2012" - "CODEN: CANCA" - "Source: Scopus"
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MSK Authors
  1. Yeo Goo Chang
    1 Chang
  2. Ariela Noy
    206 Noy
  3. Susan Slovin
    184 Slovin
  4. Michael Morris
    277 Morris
  5. Maura N Dickler
    238 Dickler
  6. Richard D Carvajal
    133 Carvajal
  7. Tomer T Levin
    58 Levin
  8. Mary Louise Keohan
    65 Keohan
  9. Andrew Saul Epstein
    69 Epstein
  10. Eileen O'Reilly
    321 O'Reilly