Video May Aid End-of-Life Decision-Making

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Watching a video about end-of-life care options may help patients with advanced heart failure choose the approach best for them, a new study finds.

The choices include comfort-focused care versus more invasive care that could extend their days.

“Because the course of heart failure is uncertain, in part because of improved therapies, doctors may be reluctant to initiate a conversation with their patients about advance care planning,” said study lead author Dr. Areej El-Jawahri.

She is director of the bone marrow transplant survivorship program at Massachusetts General Hospital Cancer Center in Boston, and a member of the Video Images of Disease for Ethical Outcomes Consortium, which develops videos for decision-making support.

Heart failure means the heart struggles to provide the body with enough blood to remain healthy. People with advanced heart failure tend to feel short of breath and fatigued with little or no activity, and they often need hospitalization.

The study included 246 advanced heart failure patients, average age 81, who were given verbal descriptions of three end-of-life care options.

These options included: life-prolonging care such as CPR, having a tube inserted into their windpipe and being placed on a breathing machine; limited care such as intravenous therapy and hospitalization, but no CPR or breathing machine; and comfort care.

Comfort care, which is typically provided at home, focuses on quality of life. It can include hospitalization if required for symptom relief.

Half the patients also watched a six-minute video that was narrated by a doctor and depicted the three levels of care. These patients were also encouraged to discuss end-of-life care with their doctor.

The findings were published online June 29 in the journal Circulation.

“We found that when patients were better informed, it’s easier for them and their doctors to discuss end-of-life issues,” El-Jawahri said in a journal news release.

Compared to those who did not see the video, patients who watched it were more likely to prefer comfort care (51 percent vs. 37 percent), almost twice as likely to say they did not want CPR, and much more likely to say they did not want a breathing machine (77 percent vs. 48 percent).

The video viewers were also four times more likely to discuss their end-of-life choices with their doctor within three months, the study found.

Patients who watched the video also were much more knowledgeable about end-of-life care levels than the others, according to the U.S. National Heart, Lung, and Blood Institute-funded study.

More information

The American Academy of Family Physicians has more on heart failure.

Source: HealthDay

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