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

描述(由研究人员提供)：由于延长生命技术的进步，越来越多的患者患有晚期心脏病，这增加了需要向医生传达他们对未来医疗护理的偏好的患者人数。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。高级护理计划(ACP)是患者在决策受损的情况下计划未来医疗护理的过程。知情的非加太计划可能是一个复杂的过程。仅靠口头或书面描述很难现实地设想未来的护理。视频是一种未得到充分利用的媒介，它可以通过提供逼真且易于理解的护理视觉图像来提高患者和医生之间的理解和沟通，从而增强对ACP的口头和书面方法。我们已经开发了一种实验方法，使用医疗干预的视频图像来更好地告知患者他们未来医疗保健的选择。我们已经成功地在癌症和痴呆症患者身上测试了这种方法。研究计划：我们建议对患有晚期心力衰竭的受试者进行随机对照试验，以检查护理目标的视频辅助决策是否可以影响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。《特定目标3》探讨了这段视频在一年后的效果。并且，《特定目标4》使用定性的方法来探索受试者对心力衰竭的信念和态度。主要结果是受试者是否希望在生命结束时在研究的两个分支中尝试延长生命的干预措施。未来方向：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，这些疾病涉及到是否进行维持生命治疗的困难决定。 公共卫生相关性：未来是否尝试对晚期心力衰竭患者进行医疗干预包括患者面临的一些最困难的决策。医生和公众都对帮助临床决策的提前护理计划表现出了高度的兴趣。我们的研究探索了使用视频决策辅助工具来辅助晚期心力衰竭患者与他们的医生之间的讨论。目前的工作是在心力衰竭的情况下提前使用视频决策辅助工具进行护理规划讨论，这将作为涉及困难决策的其他常见疾病的原型。

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. PUBLIC HEALTH RELEVANCE: Whether or not to have medical interventions attempted in the future for patients with advanced heart failure includes some of the most difficult decision-making confronting patients. 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 patients with advanced heart failure and their physicians. The present work of using video decision aids in advance care planning discussions in the context of heart failure will serve as a prototype for other common diseases that involve difficult decisions.