Video Tools Shown to Improve Patients' Decision Making About Their Care

Areej El-Jawahri, MD

Areej El-Jawahri, MD

A picture may indeed be worth a thousand words, as research is now revealing that video tools can go a long way in helping patients with advanced cancer better understand their treatment options and make decisions that align with their quality-of-life goals and preferences for care.

Studies demonstrating how short videos can enhance—though not replace—patient and family treatment conversations with their healthcare providers were showcased at the opening session of the 2015 Palliative Care in Oncology Symposium being held October 9-10 in Boston.

Good communication provides the foundation for all palliative care, and session co-chair James A. Tulsky, MD, set the stage by raising a question that is top-of-mind for oncology practitioners, especially in the context of treating patients with advanced disease:

What does good communication look like?

Tulsky currently chairs the Department of Psychosocial Oncology and Palliative Care at the Dana-Farber Cancer Institute and is founding director of VitalTalk (www.vitaltalk.org), a nonprofit devoted to nurturing healthier connections between clinicians and patients through communication skills teaching. He said good communication involves clinicians focusing on “asking before telling”; recognizing patients’ emotional cues; identifying what is important to them, and, especially, aligning treatments to patient goals.

Among the interventions which have been found to improve patient—provider communication and decision making is a 3-minute cardiopulmonary resuscitation (CPR) video presented at the general session by Areej El-Jawahri, MD, an oncologist at Massachusetts General Hospital.

Study authors noted that although talking about CPR preferences with patients who are hospitalized with advanced cancer is crucial to end-of-life decision making, these conversations are challenging and often avoided by clinicians. In the study reported here, for example, only 47% of participants reported having a discussion about their CPR preferences at the time of admission.

The trial had three aims: to compare the CPR preferences of hospitalized patients who saw the video with those who did not; to determine knowledge of CPR after seeing the video, and importantly, to assess patients’ comfort with the CPR video.

“We wanted to make sure that patients did not feel manipulated,” said El-Jawahri.

Patients hospitalized for advanced cancer at Massachusetts General Hospital and the Stanford Cancer Institute (N = 116), were randomized to either the CPR video arm (n = 54) or standard oncology care (n = 62). Mean age of the participants was 67 years.

Researchers found that participants who watched the video were more likely not to want CPR (81% vs 58%) and to better understood CPR (mean knowledge score 4.3 vs 3.2) than did those in the group receiving usual care. For those who watched the video, 81% found it helpful.

“Patients with advanced cancer who watched the video were overwhelmingly comfortable and would recommend it to others, El-Jawahri concluded.

In a related presentation, study coauthor Angelo Volandes, MD, president and founder of Advanced Care Planning (ACP) Decisions (acpdecisions.org) and a physician and researcher at Harvard Medical School, reported that ACP’s video support tools, which are currently being evaluated in a large randomized trial and through culturally customized versions across healthcare facilities in Hawaii, are designed to make sure that patients get the care that they want.

“While clinicians may be expert in providing medical care, we need our patients to tell us what is important to them,” he said.

Halfway through the three-and-a-half year evaluation of the ACP video interventions, he said, the results look very promising and the first hospital to use the video tool reported a 30% reduction in hospitalized deaths and an increase in hospice referrals by 25%.

“Together, we can leverage video technology to make sure that patients get the right care at the right time on their terms.”

El-Jawahri A, Temel JS, Ramchandran, et al. A randomized controlled trial of a cardiopulmonary resuscitation (CPR) video decision support tool for seriously ill hospitalized patients with advanced cancer. J Clin Oncol. 2015;33(suppl 29S; abstr 7).