Use of video to facilitate end-of-life discussions with patients with cancer: a randomized controlled trial

Abstract

Purpose: To determine whether the use of a goals-of-care video to supplement a verbal description can improve end-of-life decision making for patients with cancer.

Methods: Fifty participants with malignant glioma were randomly assigned to either a verbal narrative of goals-of-care options at the end of life (control), or a video after the same verbal narrative (intervention) in this randomized controlled trial. The video depicts three levels of medical care: life-prolonging care (cardiopulmonary resuscitation [CPR], ventilation), basic care (hospitalization, no CPR), and comfort care (symptom relief). The primary study outcome was participants' preferences for end-of-life care. The secondary outcome was participants' uncertainty regarding decision making (score range, 3 to 15; higher score indicating less uncertainty). Participants' comfort level with the video was also measured.

Results: Fifty participants were randomly assigned to either the verbal narrative (n = 27) or video (n = 23). After the verbal description, 25.9% of participants preferred life-prolonging care, 51.9% basic care, and 22.2% comfort care. In the video arm, no participants preferred life-prolonging care, 4.4% preferred basic care, 91.3% preferred comfort care, and 4.4% were uncertain (P < .0001). The mean uncertainty score was higher in the video group than in the verbal group (13.7 v 11.5, respectively; P < .002). In the intervention arm, 82.6% of participants reported being very comfortable watching the video.

Conclusion: Compared with participants who only heard a verbal description, participants who viewed a goals-of-care video were more likely to prefer comfort care and avoid CPR, and were more certain of their end-of-life decision making. Participants reported feeling comfortable watching the video.

Fig 1.

CONSORT diagram of study process and participants' flow. (*) Mini Mental Exam, The Folstein Mini-Mental Status Examination (range, 0 to 30).

Fig 2.

Knowledge assessment questionnaire used at baseline and post-interventions for both the verbal and video groups (score range, 0 to 6).

Fig 3.

Participants' goals-of-care preferences for advanced cancer in the verbal and video groups.

Fig 4.

Preferences for cardiopulmonary resuscitation at baseline and after the interventions in the verbal and video groups.