Improving End-of-Life Care for Cancer Patients with Video Decision Aids

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DESCRIPTION (provided by applicant): Advance Care Planning (ACP) is the process by which patients plan for future medical care in the event of impaired decision making. Informed ACP can be a complex process. It is very difficult to realistically envision future care solely with verbal or written descriptions. Video is an under utilized medium that can enhance verbal and written approaches to ACP by providing realistic and easily understandable visual images of care to improve understanding and communication between patients and physicians. The projects proposed in this application focus on the use of video decision aids to improve the ACP process for older persons with advanced cancer. Dr. Volandes proposes the following three projects: 1. to develop a video decision aid of the goals of care for advanced cancer; 2. to conduct a randomized trial of the goals of care video decision aid (vs. a verbal narrative) to demonstrate its ability to improve the ACP process among 210 patients aged 65 or older with advanced cancer and to compare patients' end of life preferences, as reflected in their choice of the primary goal of care, between the video and verbal narrative groups; and, 3. To study the implementation of the video decision aid in clinical practice among 50 oncologists. Through coursework, seminars, and the development and completion of the proposed research, Dr. Volandes plans to enhance his methodological skills and understanding of health services research; develop expertise in end of life decision making and ACP; and, collect data on the use of video decision aids to promote the delivery of high quality, preference sensitive end of life care for older persons. In the future, Dr. Volandes plans to use the skills he obtains to explore the use of video decision aids for older persons with other diseases. Receipt of a K08 career development award will provide the optimal pathway for Dr. Volandes to acquire additional research skills and expertise in decision making for the elderly with cancer. This award will also further his long term career goal to become a skilled and established independent investigator in the area of end-of-life decision making and communication. Treatment decisions at the end of life for cancer patients are some of the most difficult decisions confronting medicine. Both physicians and the public have shown a heightened interest in advance care planning to help clinical decision-making. Our study explores the use of video decision aids in assisting discussions between older patients with advanced cancer and their physicians. The present work of using video decision aids in end-of-life discussions in the context of cancer will serve as a prototype for other common diseases that involve difficult decisions.