Efficacy of Advance Care Planning Videos for Patients: A Randomized Controlled Trial in Cancer, Heart, and Kidney Failure Outpatient Settings

Maureen L. Douglas, Jessica Simon, Sara N. Davison, Patricia Biondo, Sunita Ghosh, Aliya Kassam and Konrad Fassbender
Additional contact information
Maureen L. Douglas: Department of Oncology, Division of Palliative Medicine, Cumming School of Medicine, University of Calgary, AB, Canada
Jessica Simon: Department of Oncology, Division of Palliative Medicine, Cumming School of Medicine, University of Calgary, AB, Canada
Sara N. Davison: Division of Nephrology & Immunology, University of Alberta, Edmonton, AB, CAN
Patricia Biondo: Department of Oncology, Division of Palliative Medicine, Cumming School of Medicine, University of Calgary, AB, Canada
Sunita Ghosh: Department of Oncology, University of Alberta, Edmonton, AB, Canada
Aliya Kassam: Department of Community Health Sciences, University of Calgary, AB, Canada
Konrad Fassbender: Department of Oncology, University of Alberta, Edmonton, AB, Canada

Medical Decision Making, 2021, vol. 41, issue 3, 292-304

Abstract: Background Patient videos about advance care planning (ACP; hereafter “Videos†), were developed to support uptake of provincial policy and address the complexity of patients’ decision-making process. We evaluate self-administered ACP Videos, compare the studies’ choice of outcomes, show correlations between the patients’ ACP actions, and discuss implications for health care policy. Objective To test the efficacy of the Videos on patients’ ACP/goals of care designation conversations with a health care provider. Design, Setting, and Participants Using a 2-arm, 1:1 randomized controlled trial, we recruited outpatients with a diagnosis of kidney failure, heart failure, metastatic lung, gastrointestinal, or gynecological cancer from 22 sites. Analysis followed the intention-to-treat principle. Interventions Videos describing the ACP process and illustrating the resuscitative, medical, and comfort levels of care. Main Outcomes and Measures The primary outcome was the proportion of participants who reported having an ACP/goals of care designation (GCD) conversation with a health care provider by 3 mo. Outcomes were measured using the Behaviours in Advance Care Planning and Actions Survey, an online survey capturing ACP attitudes, processes, and actions. Results We analyzed 241 and 217 participants at baseline and 3 mo, respectively. The proportion of participants who had an ACP/GCD conversation with a health care provider by 3 mo was significantly different between study arms (46% intervention; 32% control; adjusted odds ratio, 1.83; P = 0.032). Adjusted for the quality of conversations, there was no significant difference. Conclusions Videos as stand-alone tools do not engage individuals in high-quality ACP. Pragmatic trials are necessary to evaluate their impact on downstream outcomes when integrated into intentional, comprehensive conversations with a health care provider. Considering the strong correlation between 2 activities (physicians discussing options, patients telling health care providers preferences), policy should focus on empowering patients to initiate these conversations.

Keywords: advance care planning; goals of care designations; palliative care; patient decision aids; patient-physician communication; videos (search for similar items in EconPapers)
Date: 2021
References: View complete reference list from CitEc
Citations:

Downloads: (external link)
https://journals.sagepub.com/doi/10.1177/0272989X20985836 (text/html)

Related works:
This item may be available elsewhere in EconPapers: Search for items with the same title.

Export reference: BibTeX RIS (EndNote, ProCite, RefMan) HTML/Text

Persistent link: https://EconPapers.repec.org/RePEc:sae:medema:v:41:y:2021:i:3:p:292-304

DOI: 10.1177/0272989X20985836

Access Statistics for this article

More articles in Medical Decision Making
Bibliographic data for series maintained by SAGE Publications ().