Patient education and extracorporeal membrane oxygenation preferences of patients and providers in COVID care

Abstract

Background: Extracorporeal membrane oxygenation (ECMO) represents an important but limited treatment for patients with severe COVID-19. We assessed the effects of an educational intervention on a person's ECMO care preference and examined whether patients and providers had similar ECMO preferences.

Methods: In the Video+Survey group, patients watched an educational video about ECMO's purpose, benefits, and risks followed by an assessment of ECMO knowledge and care preferences in seven scenarios varying by hypothetical patient age, function, and comorbidities. Patients in the Survey Only group and providers didn't watch the video. Logistic regression was used to estimate the probability of agreement for each ECMO scenario between the two patient groups and then between all patients and providers.

Results: Video+Survey patients were more likely (64% vs. 17%; p = 0.02) to correctly answer all ECMO knowledge questions than Survey Only patients. Patients in both groups agreed that ECMO should be considered across all hypothetical scenarios, with predicted agreement above 65%. In adjusted analyses, patients and providers had similar predicted agreement for ECMO consideration across six of the seven scenarios, but patients showed greater preference (84% vs. 41%, p = 0.003) for the scenario of a functionally dependent 65-year-old with comorbidities than providers.

Discussion and conclusions: An educational video increased a person's ECMO knowledge but did not change their ECMO preferences. Clinicians were less likely than patients to recommend ECMO for older adults, so advanced care planning discussion between patients and providers about treatment options in critically ill patients with COVID-19 is critical.

Fig 1. Shows the flow diagram for patient and provider recruitment to the study.

Fig 2. Depicts the proportions of participating patients and providers (on the y-axis) who endorse extracorporeal membrane oxygenation (ECMO) for differing scenarios (presented on the x-axis).

The different patient groups are represented by the colored bars: blue for the Survey Only group, orange for Video+Survey, and grey for providers. In the scenarios, dep is short for dependence, and com is short for comorbidity. The scenarios list the age, whether the described person is dependent+/-, and has comorbidities +/-. The legend below the figure includes the full descriptions of the patient scenarios.