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Videos help increase communication of care goals for hospitalized older adults

A video intervention delivered to older hospital patients by palliative care educators helped increase communication and documentation of care preferences. These findings, published in JAMA Network Open, are from a study led by NIA-funded Harvard Medical School and Massachusetts General Hospital researchers.

Health care provider smiles as she talks with elderly patient who is in hospital bed

The study expanded testing of a library of short, evidence-based, plain-language videos to help hospital patients better understand the different care options in cases of serious illness, and more clearly communicate their goals of care (GOC) to physicians and family members. The video library — available in 29 different languages — was designed to be clearer than more traditional formats, such as brochures or verbal discussions with hospital staff.

The videos depict realistic scenarios of care decision conversations that can be difficult for patients and their families, including when physicians should perform life-extending procedures such as cardiopulmonary resuscitation, or when people in the later stages of Alzheimer’s disease or a related dementia should consider palliative care or hospice. The GOC videos are shown to patients using tablet computers, and can also be shared with long-distance caregivers by email or text if a patient is in isolation for COVID-19 or similar infectious disease, or incapacitated.

Previous research has shown that for various reasons — including cultural norms, fears, and lack of time — many patients do not discuss their medical care wishes with doctors or their loved ones while they are healthy enough to clearly understand their options and express their preferences. This can lead to decisions needing to be made by family or other caregivers during a medical emergency or when the patient is unconscious or on a ventilator.

This study included 10,802 adults age 65 or older at two urban hospitals in New York and Boston from July 1, 2021, to Oct. 31, 2022. The participants were randomly assigned to two groups. One received the GOC video intervention from palliative care educators — social workers and nurses trained in palliative care and GOC communication. The second group received the hospital’s usual course of care.

GOC were successfully documented for 62.2% of the patients who received the video intervention, compared with 50.1% of patients receiving the usual care. Notably, documented GOC discussions were also significantly higher in the video intervention group for populations that have previously proven least likely to have GOC documentation, including Black patients (62.9% compared to 53%), Hispanic patients (56.8% vs. 48.3%), non-English speakers (55.3% vs. 46.9%), and people living with Alzheimer’s or a related dementia (76.4% vs. 62.3%).

The researchers view these results as confirmation that video intervention could be a beneficial decision support tool for patients, families, and caregivers. The intervention could also help free up limited hospital staff time and resources while empowering patients or caregivers. Noted limitations of the study include the need for longer-term, more sustained care goals conversations as opposed to one session. The investigators hope to continue scaling up use of the video intervention to different settings, including outpatient care.

This research was supported in part by NIA grants UH3AG060626 and 1R01AG072911-01.

These activities relate to NIH’s Alzheimer’s and Related Dementias Research Implementation Milestone 12.K, "Health Equity: Inclusion and retention of underrepresented populations in clinical research.”

Reference: Volandes AE, et al. Video intervention and goals-of-care documentation in hospitalized older adults: The VIDEO-PCE randomized clinical trial. JAMA Network Open. 2023;6,9 e2332556. doi:10.1001/jamanetworkopen.2023.32556.

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