Using Videos to Facilitate Advance Care Planning for Patients with Heart Failure

描述（由研究者提供）：由于生命延长技术的进步，越来越多的患者患有晚期心脏病，增加了需要向医生传达其未来医疗护理偏好的患者人群。晚期心脏病患者必须做出影响其生命长度和质量的关键决定。预先护理计划（ACP）是患者在决策受损的情况下计划未来医疗护理的过程。知情的ACP可能是一个复杂的过程。仅仅通过口头或书面描述来现实地设想未来的护理是非常困难的。视频是一种未充分利用的媒体，可以通过提供逼真且易于理解的护理视觉图像来增强ACP的口头和书面方法，以改善患者和医生之间的理解和沟通。我们开发了一种实验方法，使用医疗干预的视频图像，以更好地告知患者他们未来医疗护理的选择。我们已经成功地在癌症和痴呆症患者中测试了这种方法。研究报告：我们建议对晚期心力衰竭受试者进行一项随机对照试验，以检查护理目标的视频决策辅助是否可以塑造晚期心力衰竭受试者对他们未来想要的护理类型的选择。具体目标1是评估与口头描述相比，视频决策辅助对晚期心力衰竭受试者临床决策的影响。具体目标2是评估视频对受试者的知识和决策冲突的影响。具体目标3探讨了视频一年后的效果。具体目标4采用定性研究方法探讨受试者对心力衰竭的信念和态度。主要结局是受试者是否希望在研究的两个组中在生命结束时尝试延长生命的干预措施。未来发展方向：评估视频决策辅助工具是否可以作为其他常见晚期疾病的原型，这些疾病涉及是否寻求维持生命治疗的困难决定。

DESCRIPTION (provided by investigator): Due to advances in life-prolonging technologies, growing numbers of patients are living with advanced heart disease, increasing the population of patients who need to communicate their preferences for future medical care to their physicians. Patients with advanced heart disease must make crucial decisions impacting the length and quality of their lives. 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. We have developed an experimental approach that uses video images of medical interventions to better inform patients about their options for future medical care. We have successfully tested this approach in patients with cancer and dementia. RESEARCH PLAN: We propose to conduct a randomized controlled trial of subjects with advanced heart failure to examine whether a video decision aid of the goals of care could shape the choices made by advanced heart failure subjects about the kind of care they would want in the future. Specific aim 1 is to assess the effect of a video decision aid on the clinical decision-making of advanced heart failure subjects as compared to a verbal description. Specific aim 2 is to assess the effects of the video on knowledge and decisional conflict of subjects. Specific aim 3 explores the effects of the video after one year. And, Specific aim 4 uses qualitative methods to explore subjects' beliefs and attitudes about heart failure. The primary outcome is whether or not subjects would want life-prolonging interventions attempted at the end of life in the two arms of the study. FUTURE DIRECTIONS: Evaluate whether a video decision aid can serve as a prototype for other common advanced diseases that involve difficult decisions regarding whether or not to pursue life-sustaining treatment.