Use of Video to Facilitate End-of-Life Discussions With Patients With Cancer: A Randomized Controlled Trial
Use of Video to Facilitate End-of-Life Discussions With Patients With Cancer: A Randomized Controlled Trial
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DOI：
10.1200/jco.2009.24.7502
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发表时间：
2010-01-10
影响因子：
45.3
通讯作者：
Volandes, Angelo E.
中科院分区：
文献类型：
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作者：
El-Jawahri, Areej;Podgurski, Lisa M.;Volandes, Angelo E.
目的确定使用护理目标视频来补充口头描述是否可以改善癌症患者的临终决策。方法在这项随机对照试验中，50名恶性胶质瘤患者被随机分配到两组，一组是在生命末期的护理目标选项的口头叙述(对照组)，另一组是在相同的口头叙述(干预)之后的一段视频。视频描述了三个级别的医疗护理：延长生命的护理(心肺复苏[CPR]，机械通气)，基本护理(住院，没有CPR)，以及舒适护理(症状缓解)。主要研究结果是参与者对临终关怀的偏好。次要结果是参与者对决策的不确定性(得分范围从3到15；得分越高，不确定性越小)。结果50名受试者被随机分配到口头叙述组(n=27)和视频组(n=23)。口头描述后，25.9%的受访者倾向于延寿护理，51.9%的受访者倾向于基本护理，22.2%的受访者倾向于舒适性护理。在视频组中，没有参与者倾向于延长生命护理，4.4%倾向于基本护理，91.3%倾向于舒适性护理，4.4%不确定(P<；.0001)。视频组的平均不确定度得分高于口语组(分别为13.7vs11.5；P<；0.002)。在干预组中，82.6%的参与者报告非常舒服地观看视频。结论与只听到口头描述的参与者相比，观看护理目标视频的参与者更倾向于舒适护理和避免CPR，并且对他们的临终决策更确定。参与者报告说，观看视频时感觉很舒服。
PurposeTo determine whether the use of a goals-of-care video to supplement a verbal description can improve end-of-life decision making for patients with cancer.MethodsFifty participants with malignant glioma were randomly assigned to either a verbal narrative of goals-of-care options at the end of life (control), or a video after the same verbal narrative (intervention) in this randomized controlled trial. The video depicts three levels of medical care: life-prolonging care (cardiopulmonary resuscitation [CPR], ventilation), basic care (hospitalization, no CPR), and comfort care (symptom relief). The primary study outcome was participants' preferences for end-of-life care. The secondary outcome was participants' uncertainty regarding decision making (score range, 3 to 15; higher score indicating less uncertainty). Participants' comfort level with the video was also measured.ResultsFifty participants were randomly assigned to either the verbal narrative (n = 27) or video (n = 23). After the verbal description, 25.9% of participants preferred life-prolonging care, 51.9% basic care, and 22.2% comfort care. In the video arm, no participants preferred life-prolonging care, 4.4% preferred basic care, 91.3% preferred comfort care, and 4.4% were uncertain (P < .0001). The mean uncertainty score was higher in the video group than in the verbal group (13.7 v 11.5, respectively; P < .002). In the intervention arm, 82.6% of participants reported being very comfortable watching the video.ConclusionCompared with participants who only heard a verbal description, participants who viewed a goals-of-care video were more likely to prefer comfort care and avoid CPR, and were more certain of their end-of-life decision making. Participants reported feeling comfortable watching the video.