Most seriously ill elderly people who view video material about the pros and cons of available resuscitation and assistive procedures decide they would rather not receive such treatment when the time comes. So says Areej El-Jawahri of Massachusetts General Hospital and the Harvard Medical School in the US, lead author of a study¹ in the Journal of General Internal Medicine², published by Springer. Their findings outline the use of videos to inform patients about heart resuscitation (CPR) and intubation to help with breathing or the administration of drugs.
These two procedures, which frequently form part of the hospitalization of the sick in their final days, are often only discussed when patients can no longer make informed decisions. To this end, the Video Images of Disease for Ethical Outcomes (VIDEO) Consortium, of which El-Jawahri is part, has developed and evaluated several decision-support tools to help patients make their end-of-life decisions.
To test the value of such videos, 75 seriously ill hospitalized elderly patients were shown a video describing CPR and intubation. Their wishes after seeing the video were then related to their physicians. The participants' reaction was tested against that of a similar group of 75 participants who did not view the video. Members of the study group were all older than 60 years with an advanced illness and a life expectancy of one year or less.
It was found that the seriously ill patients who viewed the video about CPR and intubation were more likely not to want these procedures implemented. In fact, three out of every four patients (72 percent) chose against the use of intubation, while three out of every five patients (64 percent) did not want CPR to be administered.
The video helped the patients become better informed about their options. They were more likely to give orders to their health providers about whether they wanted to forgo these procedures should the need arise. The video also prompted patients to discuss their preferences with their physicians.
The research team believes that the use of such informative videos within the hospital setting can ensure a patient-centered approach to decision-making, and ultimately improve patient care. The use of videos opens the topic of end-of-life treatment options between patients and physicians. According to El-Jawahri, it also allows patients to express their choices, and for doctors to more accurately document these for future use.
"In the era of shared decision-making, visual media such as videos can educate and empower seriously ill patients to make more informed decisions," says El-Jawahri. "These can also help physicians to deliver medical care in line with their patients' wishes."
1. El-Jawahri, A. et al (2015). A Randomized Controlled Trial of a CPR and Intubation Video Decision Support Tool for Hospitalized Patients, Journal of General Internal Medicine. DOI 10.1007/s11606-015-3200-2
2. The Journal of General Internal Medicine is the official journal of the Society of General Internal Medicine.