Using Video Images to Improve Advance Care Planning in Patients with Cancer

描述(由申请人提供)：癌症患者在生命末期最困难的决定之一是是否继续进行维持生命的治疗。由于癌症患者需要越来越多地参与临床决策过程，医生和公众都对提前护理计划(ACP)表现出了高度的兴趣。视频是一种未得到充分利用的媒介，可以帮助临床医生在临终前讨论护理目标。视频可以简明扼要地提供对ACP至关重要的复杂信息，使患者能够可视化未来。这项研究将检验视频的使用是否有助于更全面地了解晚期癌症患者的护理目标。视频决策辅助工具可能会让临床医生和患者讨论癌症患者在生命末期希望获得的护理水平。我们建议进行一项前后试验，以检查护理目标的视频决策辅助是否可以塑造晚期癌症受试者对他们未来想要的护理类型的选择。具体目标1是评估视频决策辅助对晚期癌症受试者临床决策的影响。具体目标2是评估视频对受试者决策冲突的影响。而且，具体目标3是研究护理目标的预测因素。主要结果是在观看视频后对医疗护理级别的偏好发生了变化。第二个结果是观看视频后决策冲突的变化。评估视频决策辅助工具是否可以作为其他常见临终疾病的原型，这些疾病涉及到是否进行维持生命治疗的困难决定。公共卫生相关性：癌症患者在生命末期的治疗决定是医学面临的最困难的决定之一。医生和公众都对提前护理计划(ACP)表现出高度的兴趣，以帮助临床决策。我们的研究探索了视频在帮助晚期癌症患者讨论ACP方面的应用。目前在癌症背景下的ACP讨论中使用视频的工作将作为其他常见疾病的原型，这些疾病涉及困难的决定。

DESCRIPTION (provided by applicant): One of the most difficult decisions to be made for cancer patients at the end of life is whether or not to pursue life-sustaining treatment. Both physicians and the public have shown a heightened interest in advance care planning (ACP) since cancer patients need to become increasingly involved in the clinical decision-making process. Video is an underutilized medium that can assist clinicians in end-of-life discussions of the goals of care. Video may enable patients to visualize the future by concisely providing complex information vital for ACP. This study will examine whether the use of video could facilitate a more comprehensive understanding of the goals of care for terminal cancer patients. Video decision aids may inform clinician-patient discussions about the level of care cancer patients would want at the end of life. We propose to conduct a before-and-after trial to examine whether a video decision aid of the goals of care could shape the choices made by terminal cancer 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 terminal cancer subjects. Specific aim 2 is to assess the effects of the video on decisional conflict of subjects. And, specific aim 3 is to study predictors of goals of care. The primary outcome is change in preferences for level of medical care after viewing the video. A secondary outcome is change in decisional conflict after viewing the video. Evaluate whether a video decision aid can serve as a prototype for other common end-of-life diseases that involve difficult decisions regarding whether or not to pursue life-sustaining treatment. Public Health Relevance: 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 (ACP) to help clinical decision-making. Our study explores the use of video in assisting ACP discussions for patients with terminal cancer. The present work of using video in ACP discussions in the context of cancer will serve as a prototype for other common diseases that involve difficult decisions.