(ChemotherapyAdvisor) – Patients with advanced cancer who viewed a video depicting a patient on a ventilator and cardiopulmonary resuscitation (CPR) being performed on a simulated patient were less likely to opt for CPR than those who listened to a verbal narrative, a study reported in the Journal of Clinical Oncology online December 10.
Noting that “end-of-life decision making can be challenging and emotionally charged” and that “physicians often do not effectively inform terminally ill patients about available medical procedures, including CPR,” Angelo E. Volandes, MD, MPH, Massachusetts General Hospital, Boston, MA, and colleagues examined the effect of a video decision support tool on CPR preferences among patients with advanced cancer.
They randomized 150 patients from four outpatient oncology centers to listen to a verbal narrative describing CPR and the likelihood of successful resuscitation (control arm; n=80) or to listen to the identical narrative and view a 3-minute video (n=70). Primary outcome was preference for or against CPR, “measured immediately after exposure to either modality.”
Participant knowledge of CPR, scored from 0 to 4, with the higher score indicating more knowledge, as well as comfort with video were the secondary outcomes.
Mean age was 62 years, where 49% were women, 44% were African American or Latino, and 47% had lung or colon cancer.
“After the verbal narrative, in the control arm, 38 participants (48%) wanted CPR, 41 (51%) wanted no CPR, and one (1%) was uncertain,” Dr. Volandes noted. “In contrast, in the intervention arm, 14 participants (20%) wanted CPR, 55 (79%) wanted no CPR, and 1 (1%) was uncertain (unadjusted odds ratio 3.5; 95% CI 1.7–7.2; P<0.001).”
Mean knowledge score in the intervention arm was 3.3 ± 1.0 (median score, 4), higher than that found in the control arm (2.6 ± 1.3; median score, 3 (P<0.001). The majority (93%) in the intervention arm were comfortable watching the video.
“To the best of our knowledge, this study represents the only multisite randomized trial of a video decision support tool for end-of-life decision making among patients with advanced cancer conducted to date,” the authors wrote.
“As society adapts to the informational power of visual images, clinicians and health care systems can also harness these tools to educate and empower patients,” they added. “This trial suggests that videos are an important tool to enhance patients’ decision making by making sure patients understand CPR and are able to express their preferences at the end of life.”