Video can help patients make end-of-life decisions
May 29, 2009Viewing a video showing a patient with advanced dementia interacting with family and caregivers may help elderly patients plan for end-of-life care, according to a study led by Massachusetts General Hospital (MGH) researchers. In their report in the journal BMJ, being released online today, the investigators find that participants who watched such a video in addition to listening to a verbal description of the condition were more likely to indicate they would choose only comfort care if they developed advanced dementia and also said they felt the video was helpful to their decision-making process.
"Decisions at the end of life can be complex and abstract; the video makes it real," says Angelo Volandes, MD, of the MGH Department of Medicine, the study's lead author. "Patients may not have experience with conditions like advanced dementia or the medical interventions involved, other than what they have seen on television or at the movies. Videos of real patients can offer more realistic images."
Asking patients about their preferences for treatment in situations they may face in the future is an essential part of quality care, the authors note; but giving patients a clear understanding of the options they are considering and making sure that messages delivered by different health care providers are consistent can be challenging. Terms that have a specific meaning to medical professionals may be interpreted very differently by the general public.
To give patients a clearer idea of what advanced dementia involves, the research team developed a decision support tool combining a standard verbal description of advanced dementia - including the fact that patients with the condition cannot move about independently, eat by themselves or communicate with others - and a two-minute video of an 80-year-old dementia patient that clearly shows her inability to walk, to eat or to communicate with family members. While the system had been evaluated in a previous study involving middle-aged participants, it had not previously been tested in older individuals or in a way that allows comparison to verbal explanation only.
The current study enrolled 200 patients from four primary care or geriatric practices in the Boston area. Participants were 65 or older and had no significant cognitive impairment, based on a standard test of mental functioning. After an initial introductory interview - which included gathering basic demographic and personal health information, along with assessment of their knowledge about dementia - about half the participants listened to a narrative describing advanced dementia and then watched the video. The other participants, the control group, only heard the narrative description. Then all participants had a second interview that included asking their preferences for the type of care they would prefer to receive if they developed advanced dementia - the options being care designed to prolong life at all costs, limited care designed to maintain physical functioning, and comfort care focused on relieving pain and maximizing comfort.
Among the control group that only heard the narrative description of advanced dementia, 64 percent of participants indicated they would choose comfort care, 19 percent limited care and 14 percent would prefer life-prolonging care. Among participants who also viewed the video, 86 percent said they would choose comfort care, while 9 percent choose limited care and only 4 percent indicated life-prolonging care. Most participants were contacted six weeks later and again asked about their care preferences, and while 29 percent of the control group indicted a change, only 6 percent of those viewing the video had changed their preferences.
"We also asked those who watched the video about their response to it, and the vast majority said they found it to be helpful, were comfortable watching it and would recommend it to others. We want patients to be as informed as possible when making decisions at the end of life but not coerce them or unduly influence them in any manner," Volandes explains.
"Since projections indicate that more than 13 million patients will develop dementia by 2050, it is critical that patients understand their options for end-of-life treatment and be able to communicate their preferences to their physicians," he adds. "Using videos in patient-doctor discussions is new, so we need further work and studies before the use of videos like this can become a standard part of clinical care." Volandes is an instructor in Medicine at Harvard Medical School.
-
End-stage dementia patients deserve the same access to palliative care as people with cancer
May 12, 2008 |
not rated yet |
0
-
End-of-life preferences appear to remain stable as health declines
Oct 27, 2008 |
not rated yet |
0
-
Study questions accuracy of mortality statistics
Dec 10, 2008 |
not rated yet |
0
-
Study: Doctor-patient conversations at end of life associated with lower medical expenses
Mar 09, 2009 |
not rated yet |
0
-
Black patients with terminal cancer more likely to choose aggressive care at end of life
May 30, 2008 |
not rated yet |
0
-
Engineers build first sub-10-nm carbon nanotube transistor
Feb 01, 2012 |
4.9 / 5 (31) |
30
-
Something old, something new: Evolution and the structural divergence of duplicate genes
Jan 31, 2012 |
4.6 / 5 (7) |
1
-
The hidden nanoworld of ice crystals: Revealing the dynamic behavior of quasi-liquid layers
Jan 30, 2012 |
5 / 5 (3) |
1
-
Stock market network reveals investor clustering
Jan 27, 2012 |
3.9 / 5 (23) |
8
-
Of microchemistry and molecules: Electronic microfluidic device synthesizes biocompatible probes
Jan 26, 2012 |
5 / 5 (1) |
0
-
Classical and Quantum Mechanics via Lie algebras
Apr 15, 2011
- More from Physics Forums - Independent Research
More news stories
Injured boomers beware: Know when to see doctor
(AP) -- It happened to nurse Jane Byron years after an in-line skating fall, business owner Haralee Weintraub while doing "men's" push-ups, and avid cyclist Gene Wilberg while lifting a heavy box.
46 minutes ago |
not rated yet |
0
FDA-approved drug rapidly clears amyloid from the brain, reverses Alzheimer's symptoms in mice
Neuroscientists at Case Western Reserve University School of Medicine have made a dramatic breakthrough in their efforts to find a cure for Alzheimer's disease. The researchers' findings, published in the journal Science, show t ...
Medicine & Health / Neuroscience
Feb 09, 2012 |
4.9 / 5 (53) |
21
|
Green tea found to reduce disability in the elderly
(Medical Xpress) -- A lot of research has been done over the past several years looking into the health benefits of green tea. As a result, scientists have found that regular consumption of the beverage leads ...
Teen school drop-outs three times as likely to be on benefits in later life
Teen school drop-outs are almost three times as likely to be on benefits in later life as their peers who complete their schooling, indicates research published online in the Journal of Epidemiology and Community Health.
Feb 06, 2012 |
not rated yet |
13
To perform with less effort, practice beyond perfection
Whether you are an athlete, a musician or a stroke patient learning to walk again, practice can make perfect, but more practice may make you more efficient, according to a surprising new University of Colorado Boulder study.
Medicine & Health / Neuroscience
Feb 09, 2012 |
4.4 / 5 (15) |
6
|
Google might launch Drive for cloud storage soon
(PhysOrg.com) -- Google's next big move, according to the Wall Street Journal, is a cloud storage service called Drive. Hardly first to the plate, Google is simply catching up to introducing its cloud reposi ...
Latin America mining boom clashes with conservation
Latin America is experiencing a mining boom as prices rise fuelled by a hike in global demand, but the region is also being hit by a wave of violent protests, strikes and rallies by environmentalists.
Love a click away in Indonesia's Twitter Republic
He was a geeky kid from Yogyakarta, she a glamorous city girl in Jakarta. In a country with one of the world's most vibrant social networking scenes they fell in love on Twitter.
Europeans protest controversial Internet pact
Tens of thousands of people marched in protests in more than a dozen European cities Saturday against a controversial anti-online piracy pact that critics say could curtail Internet freedom.
Walney offshore wind farm is world's biggest (for now)
(PhysOrg.com) -- The Walney wind farm on the Irish Sea--characterized by high tides, waves and windy weather--officially opened this week. The farm is treated in the press as a very big deal as the Walney ...
Navy to begin tests on electromagnetic railgun prototype launcher
The Office of Naval Research (ONR)'s Electromagnetic (EM) Railgun program will take an important step forward in the coming weeks when the first industry railgun prototype launcher is tested at a facility ...