Video images of advanced dementia can help patients choose the type of care they want in the future, finds a study published on bmj.com today. The images also led to more stable treatment preferences over time.
Respecting patients' preferences for treatment is a key component of high quality end of life care. Traditionally, doctors help patients engage in advance care planning by describing hypothetical situations, such as advanced dementia, and exploring possible goals of care, but this approach is limited.
Visual images have been shown to improve communication of complex health information and inform end of life decision-making. So a research team, led by Angelo Volandes at Massachusetts General Hospital, examined whether a video of a patient with advanced dementia could shape the choices made by patients about the kind of care they would want in the future.
The study involved 200 healthy people aged 65 years or above and living in the community. Background data such as age, race, sex, educational status, and marital status was recorded.
Patients were interviewed about their health and scored on their knowledge of advanced dementia before being randomly split into two groups; listening to a verbal narrative describing advanced dementia (control group) or listening to the same verbal narrative followed by watching a two minute video depicting a patient with advanced dementia (intervention group).
Participants were then interviewed again about their knowledge of advanced dementia, preferences for goals of care and, for the intervention group, their comfort with the video decision support tool.
There were three options for preferences for goals of care: life prolonging care (prolonging life at any cost), limited care (aiming to maintain physical functioning), and comfort care (aiming to maximise comfort and to relieve pain).
Among the 106 patients receiving only the verbal narrative, 68 (64%) chose comfort care, 20 (19%) chose limited care, 15 (14%) chose life prolonging care, and three (3%) were uncertain of their preferences. Among the 94 patients who also saw the video, 81 (86%) chose comfort care, eight (9%) chose limited care, four (4%) chose life prolonging care, and one (1%) was uncertain of her preferences.
Thus a significantly greater proportion of participants in the video group opted for comfort care. Those opting for comfort care were also more likely to be white, a college graduate or higher, in good health, and have greater health literacy.
Mean knowledge scores were also significantly higher in the video group compared to the control group.
After six weeks, participants were contacted again to see whether their preferences had changed. Among the 94 (89%) in the control group who could be contacted, 27 (29%) changed their preferences, while among the 84 (89%) participants contacted in the video group, five (6%) changed their preferences.
The video decision support tool was also highly acceptable to participants.
When presented with the possibility of developing advanced dementia, older patients living in the community are more likely to choose comfort as the primary goal of care after viewing a video of a patient with the disease and listening to a verbal description rather than just hearing a verbal description of advanced dementia, say the authors.
Viewing the video also improved knowledge of advanced dementia and enhanced stability of preferences for treatment over time compared with hearing only the verbal narrative.
We have shown that video decision support tools enhance elderly patients' decision making by ensuring that it is both more informed and consistent over time, conclude the authors. And they suggest that future work may extend the use of video decision support tools to other disease areas, such as advanced cancer.