Evidence

Study Design

Multi-site RCT

50% Inpatient

50% Clinic or Home

246 Patients

Control Arm

Verbal description of 
Goals of Care

Intervention Arm

Video description of
 Goals of Care

Eligibility Criteria

> 64 Years of Age
Advanced HF Diagnosis

Study Results

Patient Preferences

CPR

35% No

Verbal

68% No

Video

Patient Preferences

Intubation

48% No

Verbal

76% No

Video

Patient Preferences

Goals of Care

Verbal

41%
22%
30%
7%

Video

22%
25%
51%
2%

Life Prolonging Care Limited Medical Care Comfort Care Unsure

The Patient Experience

96%

of patients would recommend the
 video to others.

99%

of patients comfortable watching the video.

Did the patient have a
Goals of Care conversation?

After 1 Month

Verbal

6%
94%

Video

40%
60%

After 3 Months

Verbal

15%
85%

Video

61%
39%

Yes No


Hilo, Hawaii

43,000 People

Inpatient ACP Documentation

Before

3%

After

40%

Prior to implementation of the videos, the rate of ACP completion for patients with late-stage disease was 3.2%. In the 21 months after the intervention, there was an increase in ACP documentation to 39.9%.

ACP documentation included completion of an advance directive, designating a durable power of attorney, a Physician Orders for Life-Sustaining Treatment (POLST) form, or any documentation of the patient’s ACP preferences in the medical record. The primary document completed was a POLST form.

Ambulatory ACP Documentation

Hilo, Hawaii

37%

Control Region

26%

Primary care providers in Hilo had an ACP completion rate for this cohort of 37% compared to all other providers in the state, who had an average of 25.6%. (P < 0.001).

Hospital Referrals to Hospice

Before

6%

After

14%

Prior to implementation of the videos, the rate of discharge to hospice for hospitalized patients with late-stage disease was 5.7%. After the intervention, there was an increase of late-stage patients discharged to hospice to 13.8%.

$3,458

Average per patient savings for the last month of life in Hilo, Hawaii


El-Jawahri A, Temel JS, Ramachandran KJ, Jackson VA, Chang Y, Walker-Corkery ES, Mann E, Volandes AE. A randomized controlled trial of a CPR video decision support tool for seriously ill hospitalized patients with advanced cancer. Abstract accepted, ASCO Annual Meeting 2015.

















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