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dc.contributor.authorAbbo, Elmer D
dc.contributor.authorVolandes, Angelo
dc.contributor.authorPaasche-Orlow, Michael K
dc.contributor.authorBarry, Michael John
dc.contributor.authorGillick, Muriel Ruth
dc.contributor.authorMinaker, Kenneth L.
dc.contributor.authorChang, Yuchiao
dc.contributor.authorCook, Earl F.
dc.contributor.authorEl-Jawahri, Areej Raed
dc.contributor.authorMitchell, Susan Lisa
dc.date.accessioned2011-01-14T20:36:52Z
dc.date.issued2009
dc.identifier.citationVolandes, 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.issn0959-8138en_US
dc.identifier.urihttp://nrs.harvard.edu/urn-3:HUL.InstRepos:4662006
dc.description.abstractObjective: 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.isoen_USen_US
dc.publisherBMJ Publishing Group Ltd.en_US
dc.relation.isversionofdoi:10.1136/bmj.b2159en_US
dc.relation.hasversionhttp://www.ncbi.nlm.nih.gov/pmc/articles/PMC2688013/pdf/en_US
dash.licenseLAA
dc.subjectclinical trials (epidemiology)en_US
dc.subjectgeneral practiceen_US
dc.subjectfamily medicineen_US
dc.subjectlong term careen_US
dc.subjectmemory disorders (neurology)en_US
dc.subjectinterventional cardiologyen_US
dc.subjecthospiceen_US
dc.subjectmemory disorders (psychiatry)en_US
dc.subjectmechanical ventilationen_US
dc.titleVideo Decision Support Tool for Advance Care Planning in Dementia: Randomised Controlled Trialen_US
dc.typeJournal Articleen_US
dc.description.versionVersion of Recorden_US
dc.relation.journalBritish Medical Journalen_US
dash.depositing.authorMitchell, Susan Lisa
dc.date.available2011-01-14T20:36:52Z
dash.affiliation.otherHMS^Population Medicineen_US
dc.identifier.doi10.1136/bmj.b2159*
dash.authorsorderedfalse
dash.contributor.affiliatedGillick, Muriel
dash.contributor.affiliatedVolandes, Angelo
dash.contributor.affiliatedMinaker, Kenneth L.
dash.contributor.affiliatedBarry, Michael
dash.contributor.affiliatedEl-Jawahri, Areej
dash.contributor.affiliatedMitchell, Susan
dash.contributor.affiliatedCook, Earl
dash.contributor.affiliatedChang, Yuchiao


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