How many people actually have an advance directive – a living will? Many patients don’t think about it until they become ill. Sometimes, they never get around to expressing their wishes. And the default assumption is often that aggressive care should be offered.
I recently attended a conference which discussed using videos to teach patients what their decisions mean. There, Dr. Angelo Volendes discussed his research on end of life discussions with cancer patients.
Fifty patients with malignant glioma were randomly divided into two groups. One group was given description of care options at end of life verbally. The other group saw a video after the same verbal narrative.
The video depicted three levels of care: aggressive care- CPR / ventilation; basic care (hospitalization but no CPR); comfort care (symptom relief).
Relying only on verbal narrative: 26% preferred aggressive care; 52% preferred basic care; and 22% preferred comfort care.
Supplemented by video: 0% preferred aggressive care; 4% preferred basic care; and 91% preferred comfort care. The rest were uncertain.
83% said they were comfortable with the video presentation.
In other words, watching the video significantly altered patients’ choices.
Using video to make informed decisions makes sense. If one has never been in an ICU or intubated, it would be very difficult to viscerally understand what that means.