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Randomized Controlled Trial
. 2015 Aug;30(8):1071-80.
doi: 10.1007/s11606-015-3200-2. Epub 2015 Feb 18.

A Randomized Controlled Trial of a CPR and Intubation Video Decision Support Tool for Hospitalized Patients

Areej El-Jawahri  1 , Susan L Mitchell, Michael K Paasche-Orlow, Jennifer S Temel, Vicki A Jackson, Renee R Rutledge, Mihir Parikh, Aretha D Davis, Muriel R Gillick, Michael J Barry, Lenny Lopez, Elizabeth S Walker-Corkery, Yuchiao Chang, Kathleen Finn, Christopher Coley, Angelo E Volandes
Affiliations
Randomized Controlled Trial

A Randomized Controlled Trial of a CPR and Intubation Video Decision Support Tool for Hospitalized Patients

Areej El-Jawahri et al. J Gen Intern Med. 2015 Aug.

Abstract

Background: Decisions about cardiopulmonary resuscitation (CPR) and intubation are a core part of advance care planning, particularly for seriously ill hospitalized patients. However, these discussions are often avoided.

Objectives: We aimed to examine the impact of a video decision tool for CPR and intubation on patients' choices, knowledge, medical orders, and discussions with providers.

Design: This was a prospective randomized trial conducted between 9 March 2011 and 1 June 2013 on the internal medicine services at two hospitals in Boston.

Participants: One hundred and fifty seriously ill hospitalized patients over the age of 60 with an advanced illness and a prognosis of 1 year or less were included. Mean age was 76 and 51% were women.

Intervention: Three-minute video describing CPR and intubation plus verbal communication of participants' preferences to their physicians (intervention) (N = 75) or control arm (usual care) (N = 75).

Main measures: The primary outcome was participants' preferences for CPR and intubation (immediately after viewing the video in the intervention arm). Secondary outcomes included: orders to withhold CPR/intubation, documented discussions with providers during hospitalization, and participants' knowledge of CPR/ intubation (five-item test, range 0-5, higher scores indicate greater knowledge).

Results: Intervention participants (vs. controls) were more likely not to want CPR (64% vs. 32%, p <0.0001) and intubation (72% vs. 43%, p < 0.0001). Intervention participants (vs. controls) were also more likely to have orders to withhold CPR (57% vs. 19%, p < 0.0001) and intubation (64% vs.19%, p < 0.0001) by hospital discharge, documented discussions about their preferences (81% vs. 43%, p < 0.0001), and higher mean knowledge scores (4.11 vs. 2.45; p < 0.0001).

Conclusions: Seriously ill patients who viewed a video about CPR and intubation were more likely not to want these treatments, be better informed about their options, have orders to forgo CPR/ intubation, and discuss preferences with providers.

Trial registration: Clinicaltrials.gov NCT01325519 Registry Name: A prospective randomized trial using video images in advance care planning in seriously ill hospitalized patients.

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Figures

Figure 1
Figure 1
Study flow diagram.
Figure 2
Figure 2
Patients’ stated CPR and intubation preferences (baseline preferences for control arm, and post-video for the intervention arm). CPR Cardiopulmonary resuscitation.
Figure 3
Figure 3
Documented CPR and intubation preferences in the medical records (MR) prior to enrollment and at discharge. CPR Cardiopulmonary resuscitation.
Figure 4
Figure 4
Knowledge assessment comparison between the video and control groups.
Figure 5
Figure 5
Video screenshots.
See this image and copyright information in PMC

Comment in

References

    1. Diem SJ, Lantos JD, Tulsky JA. Cardiopulmonary resuscitation on television. Miracles and misinformation. N Engl J Med. 1996;334(24):1578–1582. doi: 10.1056/NEJM199606133342406. - DOI - PubMed
    1. Tulsky JA, Fischer GS, Rose MR, Arnold RM. Opening the black box: how do physicians communicate about advance directives? Ann Intern Med. 1998;129(6):441–449. doi: 10.7326/0003-4819-129-6-199809150-00003. - DOI - PubMed
    1. A controlled trial to improve care for seriously ill hospitalized patients. The study to understand prognoses and preferences for outcomes and risks of treatments (SUPPORT). The SUPPORT Principal Investigators. JAMA. 1995;274(20):1591–8. - PubMed
    1. Bailey FA, Allen RS, Williams BR, Goode PS, Granstaff S, Redden DT, et al. Do-not-resuscitate orders in the last days of life. J Palliat Med. 2012;15(7):751–759. doi: 10.1089/jpm.2011.0321. - DOI - PubMed
    1. Guo Y, Palmer JL, Bianty J, Konzen B, Shin K, Bruera E. Advance directives and do-not-resuscitate orders in patients with cancer with metastatic spinal cord compression: advanced care planning implications. J Palliat Med. 2010;13(5):513–517. doi: 10.1089/jpm.2009.0376. - DOI - PMC - PubMed

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