Angelo E. Volandes|Michael K. Paasche?Orlow|Michael J. Barry|Muriel R. Gillick|Kenneth L. Minaker|Ya-Hui Chang|E. Francis Cook|Elmer D. Abbo|Areej El?Jawahri|Susan L. Mitchell
Video decision support tool for advance care planning in dementia: randomised controlled trial
Massachusetts General Hospital|Boston University|Massachusetts General Hospital|Harvard Pilgrim Health Care|Harvard University|Massachusetts General Hospital|Massachusetts General Hospital|Brigham and Women's Hospital|University of Chicago|Massachusetts General Hospital|Hebrew SeniorLife
evaluate effect video decision support tool preferences future medical care older people develop advanced dementia stability preferences six weeksrandomised controlled trial conducted 1 september 2007 30 may 2008 setting four primary care clinics two geriatric two adult medicine affiliated three academic medical centres bostonconvenience sample 200 older people or65 years living community previously scheduled appointments one clinics mean age 75 58 womenverbal narrative alone n106 video decision support tool n94preferred goal care life prolonging care cardiopulmonary resuscitation mechanical ventilation limited care admission hospital antibiotics cardiopulmonary resuscitation comfort care treatment relieve symptoms preferences six weeks principal category analysis difference proportions participants group preferred comfort careamong participants receiving verbal narrative alone 68 64 chose comfort care 20 19 chose limited care 15 14 chose life prolonging care three 3 uncertain video group 81 86 chose comfort care eight 9 chose limited care four 4 chose life prolonging care one 1 uncertain chi2130 df3 p0003 among participants factors associated greater likelihood opting comfort care college graduate higher good better health status greater health literacy white race randomisation video arm multivariable analysis participants video group likely prefer comfort care verbal group adjusted odds ratio 39 95 confidence interval 18 86 participants reinterviewed six weeks among 94106 89 participants reinterviewed verbal group 27 29 changed preferences kappa035 among 8494 89 participants reinterviewed video group five 6 changed preferences kappa079 p0001 differenceolder people view video depiction patient advanced dementia hearing verbal description condition likely opt comfort goal care compared solely listen verbal description also stable preferences timeclinicaltrialsgov nct00704886