Video Decision Support Tool for Advance Care Planning in Dementia: Randomised Controlled Trial

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Video Decision Support Tool for Advance Care Planning in Dementia: Randomised Controlled Trial

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dc.contributor.author Abbo, Elmer D
dc.contributor.author Volandes, Angelo
dc.contributor.author Paasche-Orlow, Michael K
dc.contributor.author Barry, Michael John
dc.contributor.author Gillick, Muriel Ruth
dc.contributor.author Minaker, Kenneth L.
dc.contributor.author Chang, Yuchiao
dc.contributor.author Cook, Earl F.
dc.contributor.author El-Jawahri, Areej Raed
dc.contributor.author Mitchell, Susan Lisa
dc.date.accessioned 2011-01-14T20:36:52Z
dc.date.issued 2009
dc.identifier.citation Volandes, Angelo E., Michael K. Paasche-Orlow, Michael J. Barry, Muriel R. Gillick, Kenneth L. Minaker, Yuchiao Chang, E. Francis Cook, et al. 2009. Video decision support tool for advance care planning in dementia: randomised controlled trial. British Medical Journal 338:b2159. en_US
dc.identifier.issn 0959-8138 en_US
dc.identifier.uri http://nrs.harvard.edu/urn-3:HUL.InstRepos:4662006
dc.description.abstract Objective: To evaluate the effect of a video decision support tool on the preferences for future medical care in older people if they develop advanced dementia, and the stability of those preferences after six weeks. Design: Randomised controlled trial conducted between 1 September 2007 and 30 May 2008. Setting: Four primary care clinics (two geriatric and two adult medicine) affiliated with three academic medical centres in Boston. Participants: Convenience sample of 200 older people (≥65 years) living in the community with previously scheduled appointments at one of the clinics. Mean age was 75 and 58% were women. Intervention: Verbal narrative alone (n=106) or with a video decision support tool (n=94). Main outcome measures: Preferred goal of care: life prolonging care (cardiopulmonary resuscitation, mechanical ventilation), limited care (admission to hospital, antibiotics, but not cardiopulmonary resuscitation), or comfort care (treatment only to relieve symptoms). Preferences after six weeks. The principal category for analysis was the difference in proportions of participants in each group who preferred comfort care. Results: Among participants receiving the verbal narrative alone, 68 (64%) chose comfort care, 20 (19%) chose limited care, 15 (14%) chose life prolonging care, and three (3%) were uncertain. In the video group, 81 (86%) chose comfort care, eight (9%) chose limited care, four (4%) chose life prolonging care, and one (1%) was uncertain (χ2=13.0, df=3, P=0.003). Among all participants the factors associated with a greater likelihood of opting for comfort care were being a college graduate or higher, good or better health status, greater health literacy, white race, and randomisation to the video arm. In multivariable analysis, participants in the video group were more likely to prefer comfort care than those in the verbal group (adjusted odds ratio 3.9, 95% confidence interval 1.8 to 8.6). Participants were re-interviewed after six weeks. Among the 94/106 (89%) participants re-interviewed in the verbal group, 27 (29%) changed their preferences (κ=0.35). Among the 84/94 (89%) participants re-interviewed in the video group, five (6%) changed their preferences (κ=0.79) (P<0.001 for difference). Conclusion: Older people who view a video depiction of a patient with advanced dementia after hearing a verbal description of the condition are more likely to opt for comfort as their goal of care compared with those who solely listen to a verbal description. They also have more stable preferences over time. en_US
dc.language.iso en_US en_US
dc.publisher BMJ Publishing Group Ltd. en_US
dc.relation.isversionof doi:10.1136/bmj.b2159 en_US
dc.relation.hasversion http://www.ncbi.nlm.nih.gov/pmc/articles/PMC2688013/pdf/ en_US
dash.license LAA
dc.subject clinical trials (epidemiology) en_US
dc.subject general practice en_US
dc.subject family medicine en_US
dc.subject long term care en_US
dc.subject memory disorders (neurology) en_US
dc.subject interventional cardiology en_US
dc.subject hospice en_US
dc.subject memory disorders (psychiatry) en_US
dc.subject mechanical ventilation en_US
dc.title Video Decision Support Tool for Advance Care Planning in Dementia: Randomised Controlled Trial en_US
dc.type Journal Article en_US
dc.description.version Version of Record en_US
dc.relation.journal British Medical Journal en_US
dash.depositing.author Mitchell, Susan Lisa
dc.date.available 2011-01-14T20:36:52Z
dash.affiliation.other HMS^Population Medicine en_US

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