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

描述（由申请人提供）：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介，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。本申请中提出的项目侧重于使用视频决策辅助工具，以改善老年晚期癌症患者的ACP过程。沃兰德斯博士提出了以下三个项目：1。开发一个关于晚期癌症护理目标的视频决策辅助工具; 2.进行护理视频决策辅助的目标的随机试验（与口头叙述相比），以证明其在210名65岁或65岁以上晚期癌症患者中改善ACP过程的能力，并比较视频和口头叙述组之间患者的生命终了偏好，如他们对护理的主要目标的选择所反映的;以及3.目的：研究50名肿瘤科医师在临床实践中实施视频决策辅助的情况。通过课程，研讨会，以及拟议研究的开发和完成，Volandes博士计划提高他的方法技能和对卫生服务研究的理解;发展生命决策和ACP的专业知识;并收集有关使用视频决策辅助工具的数据，以促进为老年人提供高质量，对偏好敏感的临终关怀。在未来，Volandes博士计划利用他获得的技能，探索使用视频决策辅助老年人与其他疾病。获得K 08职业发展奖将为Volandes博士提供最佳途径，使其获得额外的研究技能和癌症老年人决策方面的专业知识。这一奖项也将进一步他的长期职业目标，成为一个熟练的和建立在生命结束的决策和沟通领域的独立调查员。 癌症患者生命末期的治疗决定是医学面临的最困难的决定之一。医生和公众都表现出了高度的兴趣，提前护理计划，以帮助临床决策。我们的研究探讨了使用视频辅助决策，以协助晚期癌症老年患者和他们的医生之间的讨论。目前在癌症背景下使用视频决策辅助工具进行临终讨论的工作将成为其他涉及困难决策的常见疾病的原型。

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.