Videos illuminate realities of end-stage procedures

Medical ResearchMassachusetts General HospitalHarvard Medical School

End-of-life choices and treatment decisions are rarely discussed in the medical community, despite expert advice meant to encourage communication, studies suggest. As a result, many patients spend their final days receiving invasive treatments that they might not have chosen if they had known more about them.

However, there is a unique series of videos designed to shed light on the reality of aggressive end-of-life treatments, which are often portrayed on television as being more successful than they are.

Studies using these simple but realistic videos have shown that patients with life-limiting illnesses are likely to change their preferences from invasive treatment to comfort-based approaches after watching the videos, which range from 3 to 10 minutes.

The 25 videos demonstrate common end-of-life hospital procedures, including CPR, breathing machines, blood transfusions and bronchoscopies.

Dr. Angelo Volandes, an internist and researcher at Harvard Medical School and Massachusetts General Hospital and co-founder of the nonprofit foundation Advance Care Planning Decisions (acpdecisions.org), explains why the educational videos can supplement — but not supplant — patient-doctor relationships.

The videos are only available to medical professionals, and patients view them first with a doctor in a clinical setting. Later, the patient can also watch them with their families. Eventually, Volandes hopes the videos will be available to people outside the medical profession. "The whole point is to change the culture about how we have these conversations in our society," he said.

Below is an edited transcript of our talk with him.

Q: Why are the videos effective?

A: Pictures speak a thousand words. The videos speak hundreds of thousands of words. We're a visually literate society, but we are still talking to patients as Hippocrates did 2,000 years ago. I always make it clear the videos are not meant to replace the patient-doctor relationship; it's to reinforce it. It's about empowering, giving patients the means to understand. Doctors aren't always trained to have these conversations.

Q: Do they coerce patients?

A: We ask patients whether they were comfortable watching the videos. In a study published in the Journal of Clinical Oncology, 97 percent said they were. What's really remarkable though is the finding in our studies that more than 95 percent of patients said they would recommend the video to other patients. That's the gold standard. If they're comfortable, find it helpful and would recommend it to others, that suggests it's fair and impartial.

Q: How can watching the video help change a patient's mind?

A: It gives the patients greater understanding that when they have a life-limiting illness, many interventions (such as CPR) don't have a great likelihood of success. They think, 'Why put my family through that when my chance of surviving is so low?' We don't do a good job of explaining interventions and what happens when you have something like cancer. Most patients believe they will be back to normal. The videos help them understand what the procedures look like. They standardize the conversation and makes sure you have the information you need to make decisions.

jdeardorff@tribune.com

Copyright © 2014, Los Angeles Times
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