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J Palliat Med. 2018 Jun;21(6):766-772. doi: 10.1089/jpm.2017.0351. Epub 2018 Mar 13.

Feasibility and Patient Perceptions of Video Declarations Regarding End-of-Life Decisions by Hospitalized Patients.

Author information

1
1 Section of General Internal Medicine, Department of Medicine, Boston University School of Medicine , Boston, Massachusetts.
2
2 Department of Medicine, Harvard Medical School, Massachusetts General Hospital , Boston, Massachusetts.

Abstract

BACKGROUND:

A videotaped declaration by patients of their advance care planning preferences could be an opportunity to supplement advance directive forms and be a source of information for family, caregivers, and clinicians, yet research is needed to examine the content and acceptability of making declarations among patients.

OBJECTIVE:

To evaluate the content and acceptability of 'video declarations': the process of patients videotaping themselves describing their advance care planning preferences.

DESIGN:

We showed a brief video describing three approaches to end-of-life care and then invited participants to use an iPad to videotape themselves making a declaration about their wishes.

SETTING/SUBJECTS:

Hospitalized patients from a large urban U.S. safety net hospital.

MEASUREMENTS:

We interviewed participants about the acceptability of the declaration process. Declarations were transcribed and coded by a team, with multiple stakeholder input.

RESULTS:

There were 16 participants; mean age was 60 (SD = 14) years. One participant declined. Out of 15 declarations, most were able to express their wishes for CPR (n = 12) and intubation (n = 13). Participants frequently discussed their family structure (n = 11), religious/spiritual well-being (n = 8), legacy/dignity issues (n = 6), and physical symptoms (n = 6). Nine declarations had directives judged to be unclear. The majority (66%) thought that this process was quite a bit or extremely helpful.

CONCLUSIONS:

Findings show that asking hospitalized patients to make videos describing their advance care planning preferences was feasible and acceptable. While the majority described their wishes around CPR and intubation, a fair amount of uncertainty remained. Further research is needed to support patients in describing their wishes clearly and test the effectiveness of video declarations to promote care concordant with preferences.

KEYWORDS:

advance care planning; underserved populations; video

PMID:
29649398
PMCID:
PMC5995264
[Available on 2019-06-01]
DOI:
10.1089/jpm.2017.0351

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