Improving patient knowledge of palliative care: A randomized controlled intervention study. Completing a life: comfort level and ease of use of a CD-ROM among seriously ill patients. A telehealth behavioral coaching intervention for neurocognitive disorder family carers Randomized, Controlled Trial of an Advance Care Planning Video Decision Support Tool for Patients With Advanced Heart Failure Use of video to facilitate end-of-life discussions with patients with cancer: a randomized controlled trial. A randomized controlled trial of a cardiopulmonary resuscitation video in advance care planning for progressive pancreas and hepatobiliary cancer patients. Assessing end-of-life preferences for advanced dementia in rural patients using an educational video: a randomized controlled trial. Using video images to improve the accuracy of surrogate decision-making: a randomized controlled trial. Practical methods to increase use of advance medical directives Effect of the Goals of Care Intervention for Advanced Dementia: A Randomized Clinical Trial Brief DVD-based educational intervention for patients with cancer pain: feasibility study Effectiveness of a psychoeducational skill training DVD program to reduce stress in Chinese American dementia caregivers: Results of a preliminary study Comparative Outcomes of Two Distance-Based Interventions for Male Caregivers of Family Members With Dementia Effectiveness of end-of-life education among community-dwelling older adults 'We have to discuss it': cancer patients' advance care planning impressions following educational information about cardiopulmonary resuscitation. Concordance Between Proxy Level of Care Preference and Advance Directives Among Nursing Home Residents With Advanced Dementia: A Cluster Randomized Clinical Trial.
OBJECTIVES To determine if laypersons ' knowledge about palliative care can improve with a brief education intervention . METHODS 152 adults were recruited to participate in a web-based r and omized intervention trial that followed a 2 (content) × 2 ( format ) between-subjects design . Groups received either a video intervention , an information page intervention , a video control , or an information page control . An ANCOVA with contrast coding of two factors was utilized to assess if knowledge , as measured by the Palliative Care Knowledge Scale ( PaCKS ) , increased post intervention . RESULTS There was a significant difference between intervention group means and control group means on PaCKS scores from T1 to T2 F(1 , 139)=11.10 , p=0.00 , ηp2=0.074 . There was no significant difference in PaCKS change scores between the video intervention and information page intervention . CONCLUSIONS This study demonstrates that an information page and a brief video can improve knowledge of palliative care in laypersons . PRACTICE IMPLICATION S Self-administered educational interventions could be made available in diverse setting s in order to reach patients and their families who may benefit from but are unaware of palliative care . Interventions more intensive than the one tested in this study might result in even more significant improvements in knowledge PURPOSE / OBJECTIVES To evaluate use of a CD-ROM titled Completing a Life among patients diagnosed with serious illnesses for comfort level with content and ease of computer use . DESIGN A prospect i ve pilot study collected a convenience sample of 50 people diagnosed with life-limiting illnesses during a six-month period . SETTING The hematology/oncology department of a large healthcare system located in a metropolitan area in the midwestern United States . SAMPLE Convenience sample of 50 patients diagnosed with life-limiting illnesses . Of the patients enrolled ( age range = 38 - 93 years ) , 72 % were female , 68 % were Caucasian , 50 % were diagnosed with breast cancer or nonsolid tumors , and 40 % were newly diagnosed . METHODS Subjects viewed the CD-ROM and completed pre- and post-intervention surveys . MAIN RESEARCH VARIABLES Comfort level with educational media , comfort level of information viewed , and areas of CD-ROM viewed compared to age and stage of illness . FINDINGS Ninety percent of patients reported that they were somewhat or very comfortable with the CD-ROM  as a learning tool , and ease of use was rated at 98 % . Patients ' comfort level with the material increased from 76 % to 90 % after they viewed the CD-ROM . CONCLUSIONS The pilot study suggests that the Completing a Life CD-ROM can be used with patients facing serious or life-limiting illnesses as an additional re source tool for information . IMPLICATION S FOR NURSING Nurses typically provide the bulk of educational material for their patients . With limited re sources available regarding management of life-limiting illnesses , this re source may provide an excellent addition to re sources currently available Objectives This study examined the differential impact of two telehealth programs for women caring for an older adult with a neurocognitive disorder . Outcomes examined were depressive symptoms , upset following disruptive behaviors , anxious and angry mood states , and caregiving self‐efficacy . Methods Women cohabitating with a family member diagnosed with a neurocognitive disorder were assigned via r and om allocation to either of the following : ( 1 ) a 14‐week behavioral intervention using video instructional material s , workbook and telephone coaching in behavioral management , pleasant events scheduling , and relaxation or ( 2 ) a basic education guide and telephone support comparison condition . Telephone assessment s were conducted by interviewers blind to treatment condition at pre‐intervention , post‐intervention , and 6 months following intervention . Results For those providing in‐home care at post‐treatment , depressive symptoms , upset following disruptive behaviors , and negative mood states were statistically lower in the behavioral coaching condition than in the basic education and support condition . Reliable change index analyses for Beck Depression Inventory II scores favored the behavioral coaching condition . Caregiving self‐efficacy scores for obtaining respite and for managing patient behavioral disturbances were significantly higher in the coaching condition . Effect sizes were moderate but not maintained at the 6‐month follow‐up . Conclusions This study provides some initial evidence for the efficacy of a telehealth behavioral coaching intervention compared with basic education and telephone support . Carers ' abilities to maintain strategy use during progressive disorders such as Alzheimer 's disease likely require longer intervention contact than provided in the current study . Dementia carers , including those living in rural areas , can benefit from accessible and empirically supported interventions that can be easily disseminated across distances at modest cost . © 2015 The Authors . International Journal of Geriatric Psychiatry Published by John Wiley & Sons , Background : Conversations about goals of care and cardiopulmonary resuscitation (CPR)/intubation for patients with advanced heart failure can be difficult . This study examined the impact of a video decision support tool and patient checklist on advance care planning for patients with heart failure . Methods : This was a multisite , r and omized , controlled trial of a video-assisted intervention and advance care planning checklist versus a verbal description in 246 patients ≥64 years of age with heart failure and an estimated likelihood of death of > 50 % within 2 years . Intervention participants received a verbal description for goals of care ( life-prolonging care , limited care , and comfort care ) and CPR/intubation plus a 6-minute video depicting the 3 levels of care , CPR/intubation , and an advance care planning checklist . Control subjects received only the verbal description . The primary analysis compared the proportion of patients preferring comfort care between study arms immediately after the intervention . Secondary outcomes were CPR/intubation preferences and knowledge ( 6-item test ; range , 0–6 ) after intervention . Results : In the intervention group , 27 ( 22 % ) chose life-prolonging care , 31 ( 25 % ) chose limited care , 63 ( 51 % ) selected comfort care , and 2 ( 2 % ) were uncertain . In the control group , 50 ( 41 % ) chose life-prolonging care , 27 ( 22 % ) selected limited care , 37 ( 30 % ) chose comfort care , and 8 ( 7 % ) were uncertain ( P<0.001 ) . Intervention participants ( compared with control subjects ) were more likely to forgo CPR ( 68 % versus 35 % ; P<0.001 ) and intubation ( 77 % versus 48 % ; P<0.001 ) and had higher mean knowledge scores ( 4.1 versus 3.0 ; P<0.001 ) . Conclusions : Patients with heart failure who viewed a video were more informed , more likely to select a focus on comfort , and less likely to desire CPR/intubation compared with patients receiving verbal information only . Clinical Trial Registration : URL : http://www . clinical trials.gov . Unique identifier : NCT01589120 PURPOSE To determine whether the use of a goals -of-care video to supplement a verbal description can improve end-of-life decision making for patients with cancer . METHODS Fifty participants with malignant glioma were r and omly assigned to either a verbal narrative of goals -of-care options at the end of life ( control ) , or a video after the same verbal narrative ( intervention ) in this r and omized controlled trial . The video depicts three levels of medical care : life-prolonging care ( cardiopulmonary resuscitation [ CPR ] , ventilation ) , basic care ( hospitalization , no CPR ) , and comfort care ( symptom relief ) . The primary study outcome was participants ' preferences for end-of-life care . The secondary outcome was participants ' uncertainty regarding decision making ( score range , 3 to 15 ; higher score indicating less uncertainty ) . Participants ' comfort level with the video was also measured . RESULTS Fifty participants were r and omly assigned to either the verbal narrative ( n = 27 ) or video ( n = 23 ) . After the verbal description , 25.9 % of participants preferred life-prolonging care , 51.9 % basic care , and 22.2 % comfort care . In the video arm , no participants preferred life-prolonging care , 4.4 % preferred basic care , 91.3 % preferred comfort care , and 4.4 % were uncertain ( P < .0001 ) . The mean uncertainty score was higher in the video group than in the verbal group ( 13.7 v 11.5 , respectively ; P < .002 ) . In the intervention arm , 82.6 % of participants reported being very comfortable watching the video . CONCLUSION Compared with participants who only heard a verbal description , participants who viewed a goals -of-care video were more likely to prefer comfort care and avoid CPR , and were more certain of their end-of-life decision making . Participants reported feeling comfortable watching the video BACKGROUND  Cardiopulmonary resuscitation ( CPR ) is an important advance directive ( AD ) topic in patients with progressive cancer ; however such discussion s are challenging . OBJECTIVE This study investigates whether video educational information about CPR engenders broader advance care planning ( ACP ) discourse . METHODS Patients with progressive pancreas or hepatobiliary cancer were r and omized to an educational CPR video or a similar CPR narrative . The primary end-point was the difference in ACP documentation one month posttest between arms . Secondary end-points included study impressions ; pre- and post-intervention knowledge of and preferences for CPR and mechanical ventilation ; and longitudinal patient outcomes . RESULTS Fifty-six subjects were consented and analyzed . Rates of ACP documentation ( either formal ADs or documented discussion s ) were 40 % in the video arm ( 12/30 ) compared to 15 % in the narrative arm ( 4/26 ) , OR=3.6 [ 95 % CI : 0.9 - 18.0 ] , p=0.07 . Post-intervention knowledge was higher in both arms . Posttest , preferences for CPR had changed in the video arm but not in the narrative arm . Preferences regarding mechanical ventilation did not change in either arm . The majority of subjects in both arms reported the information as helpful and comfortable to discuss , and they recommended it to others . More deaths occurred in the video arm compared to the narrative arm , and more subjects died in hospice setting s in the video arm . CONCLUSIONS This pilot r and omized trial addressing downstream ACP effects of video versus narrative decision tools demonstrated a trend towards more ACP documentation in video subjects . This trend , as well as other video effects , is the subject of ongoing study OBJECTIVE Few studies have evaluated the end-of-life preferences of elderly patients in rural communities and whether preferences are associated with level of health literacy . DESIGN R and omized controlled trial of a goals -of-care video decision aid of advanced dementia . PARTICIPANTS Elderly subjects ( 65 years or older ) at a primary care clinic in rural Louisiana . METHODS Half of subjects heard a verbal description of advanced dementia and the goals of care ; the other half heard the same verbal description and then viewed the video decision aid . End points were the preferred goal of care in advanced dementia : life-prolonging care ( cardiopulmonary resuscitation [ CPR ] , etc . ) , limited care ( hospitalization but not CPR ) , or comfort care ( symptom relief ) . The principal category for analysis was the difference in proportions of subjects preferring comfort care for each characteristic including r and omization group and health literacy level . RESULTS Seventy-six subjects were r and omized to the verbal ( n = 43 ) or video ( n = 33 ) arms of the study . Among subjects receiving the verbal description of advanced dementia and the goals of care , 31 ( 72 % ) preferred comfort ; 5 ( 12 % ) chose limited ; and 7 ( 16 % ) desired life-prolonging . In the video group , 30 ( 91 % ) preferred comfort ; 3 ( 9 % ) chose limited ; and none desired life-prolonging ( χ(2 ) = 6.3 , df = 2 , p = 0.047 ) . Factors associated with greater likelihood of opting for comfort included greater health literacy ( unadjusted odds ratio [ OR ] 12.1 ; 95 % confidence interval [ CI ] , 2.4 - 62.6 ) and r and omization to the video ( unadjusted OR 3.9 ; 95 % CI , 1.0 - 15.1 ) . CONCLUSION Rural subjects with higher health literacy were more likely to want comfort care compared to those with lower levels of health literacy . Furthermore , subjects who viewed a video decision aid were more likely to opt for comfort compared to those who solely listened to a verbal description . These findings suggest that video can help elicit preferences and that interventions to empower such patients need to be design ed in a manner that is sensitive to health literacy INTRODUCTION When patients are unable to make important end-of-life decisions , doctors ask surrogate decision makers to provide insight into patients ' preferences . Unfortunately , multiple studies have shown that surrogates ' knowledge of patient preferences is poor . We hypothesized that a video decision tool would improve concordance between patients and their surrogates for end-of-life preferences .  OBJECTIVE To compare the concordance of preferences among elderly patients and their surrogates listening to only a verbal description of advanced dementia or viewing a video decision support tool of the disease after hearing the verbal description . METHODS This was a r and omized controlled trial of a convenience sample of community-dwelling elderly subjects ( > or = 65 years ) and their surrogates , and was conducted at 2 geriatric clinics affiliated with 2 academic medical centers in Boston . The study was conducted between September 1 , 2007 , and May 30 , 2008 . R and om assignment of patient and surrogate dyads was to either a verbal narrative or a video decision support tool after the verbal narrative . End points were goals of care chosen by the patient and predicted goals of care by the surrogate . Goals of care included life-prolonging care ( CPR , mechanical ventilation ) , limited care ( hospitalization , antibiotics , but not CPR ) , and comfort care ( only treatment to relieve symptoms ) . The primary outcome measure was the concordance rate of preferences between patients and their surrogates . RESULTS A total of 14 pairs of patients and their surrogates were r and omized to verbal narrative ( n=6 ) or video after verbal narrative ( n=8 ) . Among the 6 patients receiving only the verbal narrative , 3 ( 50 % ) preferred comfort care , 1 ( 17 % ) chose limited care , and 2 ( 33 % ) desired life-prolonging care . Among the surrogates for these patients , only 2 correctly chose what their loved one would want if in a state of advanced dementia , yielding a concordance rate of 33 % . Among the 8 patients receiving the  video decision support tool , all 8 chose comfort care . Among the surrogates for these patients , all 8 correctly chose what their loved one would want if in a state of advanced dementia , yielding a concordance rate of 100 % . CONCLUSION Patients and surrogates viewing a video decision support tool for advanced dementia are more likely to concur about the patient 's end-of-life preferences than when solely listening to a verbal description of the disease OBJECTIVE : To compare the effectiveness of two means for increasing the use of advance medical directives : written material s only versus written material s and an educational videotape . DESIGN : Population -based , r and omized controlled trial with 3-month follow up . SETTING : Kaiser Permanente Colorado Region , a not-for-profit group-model health maintenance organization . PARTICIPANTS : A population -based sample of all 1,302 members aged 75 years and older who used the Franklin Medical Office , excluding 55 persons who died or disenrolled during the study period or were identified by their physicians as blind or cognitively impaired . INTERVENTIONS : All subjects were mailed a 10-page cartoon-illustrated educational pamphlet on patient choices , a selection of Colorado advance medical directive forms , and a guide to their completion ; 619 subjects also were mailed a 20-minute videotape on advance directives . Both groups had access to a study nurse for assistance in completing and placing advance medical directives . MEASUREMENTS AND MAIN RESULTS : The main outcome measure is the proportion of subjects who placed a directive in their medical record for the first time . Placement rates increased almost identically , from 21.2 % to 35.0 % in the written material s-only group and from 18.9 % to 32.6 % in the group receiving the videotape ( 95 % confidence interval for difference −0.04 , 0.04 , p=.952 ) . CONCLUSIONS : In an elderly population with a substantial baseline placement rate , mailing of written material s substantially increased placement of an advance directive in the medical record , but the addition of a videotape did not . Mailing the video did increase the use of treatment trials and made patients more aware of reasons not to use advance directives Importance In advanced dementia , goals of care decisions are challenging and medical care is often more intensive than desired . Objective To test a goals of care ( GOC ) decision aid intervention to improve quality of communication and palliative care for nursing home residents with advanced dementia . Design , Setting , and Participants A single-blind cluster r and omized clinical trial , including 302 residents with advanced dementia and their family decision makers in 22 nursing homes . Interventions A GOC video decision aid plus a structured discussion with nursing home health care providers ; attention control with an informational video and usual care planning . Main Outcomes and Measures Primary outcomes at 3 months were quality of communication ( QOC , question naire scored 0 - 10 with higher ratings indicating better quality ) , family report of concordance with clinicians on the primary goal of care ( endorsing same goal as the “ best goal to guide care and medical treatment , ” and clinicians ’ “ top priority for care and medical treatment ” ) , and treatment consistent with preferences ( Advance Care Planning Problem score ) . Secondary outcomes at 9 months were family ratings of symptom management and care , palliative care domains in care plans , Medical Orders for Scope of Treatment ( MOST ) completion , and hospital transfers . Resident-family dyads were the primary unit of analysis , and all analyses used intention-to-treat assignment . Results Residents ’ mean age was 86.5 years , 39 ( 12.9 % ) were African American , and 246 ( 81.5 % ) were women . With the GOC intervention , family decision makers reported better quality of communication ( QOC , 6.0 vs 5.6 ; P = .05 ) and better end-of-life communication ( QOC end-of-life subscale , 3.7 vs 3.0 ; P = .02 ) . Goal concordance did not differ at 3 months , but family decision makers with the intervention reported greater concordance by 9 months or death ( 133 [ 88.4 % ] vs 108 [ 71.2 % ] , P = .001 ) . Family ratings of treatment consistent with preferences , symptom management , and quality of care did not differ . Residents in the intervention group had more palliative care content in treatment plans ( 5.6 vs 4.7 , P = .02 ) , MOST order sets ( 35 % vs 16 % , P = .05 ) , and half as many hospital transfers ( 0.078 vs 0.163 per 90 person-days ; RR , 0.47 ; 95 % CI , 0.26 - 0.88 ) . Survival at 9 months was unaffected ( adjusted hazard ratio [ aHR ] , 0.76 ; 95 % CI , 0.54 - 1.08 ; P = .13 ) . Conclusions and Relevance The GOC decision aid intervention is effective to improve end-of-life communication for nursing home residents with advanced dementia and enhance palliative care plans while reducing hospital transfers . Trial Registration clinical trials.gov Identifier : Patient attitudes and knowledge regarding cancer pain and strong opioid analgesia can sometimes be a barrier to good pain control . Educational interventions that address these barriers are effective in oncology out patients but have not been evaluated in patients with more advanced disease . We assessed the feasibility of a r and omized , controlled clinical trial evaluating a brief DVD-based educational intervention for cancer pain in palliative care patients . Participants were shown DVD at baseline ( V1 ) and at 1 week ( V2 ) . Outcomes were assessed using Brief Pain Inventory ( BPI ) and Patient Pain Question naire ( PPQ ) before intervention , and at V2 and V3 ( 4 weeks later ) . Fifteen patients and 10 carers were recruited . Between V1 and V2 , total BPI and PPQ scores improved significantly by 9.6 % ( p = 0.02 ) and 17 % ( p = 0.04 ) respectively with no further improvements at V3 . Our findings suggest that this intervention is feasible and potentially effective between 7—30 days follow up . A multicentre clinical trial is now needed to evaluate this intervention further Prior research ( Gallagher-Thompson , D. , Gray , H. , Tang , P. , Pu , C.-Y. , Tse , C. , Hsu , S. , et al. ( 2007 ) . Impact of in-home intervention versus telephone support in reducing  depression and stress of Chinese caregivers : Results of a pilot study . American Journal of Geriatric Psychiatry , 15 , 425–434 . ) found that an in-home behavioral management program , derived conceptually from cognitive behavioral theories ( CBT ) , was effective in reducing caregiver related stress and depressive symptoms in Chinese American dementia caregivers ( CGs ) . Results were promising , but a more cost-effective intervention is needed to serve this growing population . Past work also found that a psychoeducational videotaped training program based on CBT was effective in reducing stress due to caregiving in Caucasian and African American dementia family CGs ( Steffen , 2000 , Anger management for dementia caregivers : A preliminary study using video and telephone interventions . Behavior Therapy , 31 , 281–299 . ) . To date no research has been conducted using a technological medium to deliver a similar kind of intervention to Chinese American caregivers . The present study evaluated the effectiveness of a similar but culturally “ tailored ” program in which 70 CGs were r and omly assigned to a 12-week CBT skill training program delivered on a DVD , or to a general educational DVD program on dementia . Both were available in M and arin Chinese or English as preferred . Pre post change analyses indicated that CGs did not differ on change in level of negative depressive symptoms , but positive affect was higher , and patient behaviors were appraised as less stressful and bothersome , for CGs in the CBT skill training program . They were also more satisfied with the program overall and reported that they believed they were able to give care more effectively . Results encourage further development of theoretically based interventions , delivered using modern technology , for this ever increasing group of CGs Data are presented on a preliminary study investigating the efficacy of 2 distance-based psychosocial interventions ( N = 32 ) for male family dementia caregivers . Male caregivers were r and omly assigned to either a basic education intervention ( ie , educational booklet and biweekly check-in telephone calls ) or a video intervention ( ie , set of 10 videos , an accompanying workbook , and weekly telephone coaching sessions using behavioral strategies to manage challenging caregiving situations ) . Results did not support the greater efficacy of the video condition in reducing psychosocial distress ( eg , negative affect , upset and annoyance following behavior problems ) or increasing positive affect or caregiving self-efficacy . There was , however , a statistically significant effect for postintervention improvement in both the video/coaching and the educational booklet/check-in conditions . Potential reasons for the lack of differential treatment effects are discussed , along with implication s for recruitment of male dementia caregivers The purpose of this study was to evaluate the effectiveness of an educational intervention regarding end-of-life discussion directed at older Japanese adults and their attitude to and acceptance of this intervention . A quasi-experimental design was used . A total of 121 older adults , aged 65 years and over , consented to participate . Data from 55 intervention and 57 control participants were used for the analysis . The intervention consisted of an education program comprising a video , a lecture using a h and out , and discussion among participants . The control group received only the h and out . Both groups were followed up after one month . The intervention group ’s attitude became more favorable towards advance directives , especially living wills ( P = 0.024 ) . In addition , their expression of preference for life-sustaining treatment by means of artificial nutrition was less at follow up , demonstrating that these older adults had become more autonomous ( P = 0.008 ) . There was greater acceptance of the intervention as a whole by the intervention group compared with the control group ( P = 0.011 ) . Although few participants overall completed living wills , at follow up twice as many in the intervention group had discussed end-of-life matters with family members and /or their physician OBJECTIVE Most cancer patients desire information about care options at the end of life , including  cardiopulmonary resuscitation ( CPR ) .  Communicating such care options can be challenging and is part of advance care planning ( ACP ) . Our prior studies with video educational media produced data on patients ' categoric preferences ( yes/no/unsure ) for CPR ; however , the thematic underpinnings of these educated preferences in patients treated for advanced cancer are n't well known . METHODS Qualitative thematic content analysis of participants ' responses in a r and omized trial of an educational video ( V ) or narrative ( N ) about CPR in patients with advanced gastrointestinal cancers . Responses were independently coded and categorized for thematic content by two review ers . RESULTS Of 54 study participants , 26 total ( 41 % of V arm , 56 % of N arm ) articulated questions , comments , or both . Review er analyses demonstrated thematic consensus and result ed in seven distinct themes listed in decreasing order of prevalence : ( a ) ACP should be started early ; ( b ) educational information about CPR affirmed participants ' existing beliefs/knowledge/values about advanced illness ; ( c ) participants were apprehensive about ACP but wanted to discuss it ; ( d ) gaps in knowledge about ACP emerged ; ( e ) CPR information was helpful/acceptable ; ( f ) physicians should be involved in ACP ; and ( g ) medical questions about critical illness arose . CONCLUSIONS Findings identified that while sometimes difficult to discuss , advance care planning is desired , deemed helpful , and ideally begun early by clinicians , and that video education is an appropriate and affirming initiator of discussion s. These themes are incorporated into our ongoing research on cancer patient-specific values and education about care options CONTEXT Care consistent with goals is the desired outcome of advance care planning ( ACP ) . OBJECTIVES The objectives of this study were to examine concordance between advance directives and proxy care preferences among nursing home residents with advanced dementia and to determine the impact of an ACP video on concordance . METHODS Data were from Educational Video to Improve Nursing home Care in End-stage dementia , a cluster r and omized clinical trial conducted in 64 Boston-area facilities ( 32/arm ) from 2013 to 2017 . Participants included advanced dementia residents and their proxies ( N = 328 dyads ) . At the baseline and quarterly ( up to 12 months ) , proxies stated their preferred level of care for the resident ( comfort , basic , or intensive ) and advance directives for specific treatments ( resuscitation , hospitalization , tube-feeding , intravenous hydration , antibiotics ) were abstract ed from the charts . At the baseline , proxies in intervention facilities viewed an ACP video . Their care preferences after viewing it were shared via a written communication with the primary care team . At each assessment , concordance between directives and proxy preferences was determined . RESULTS Among the residents ( mean age , 86.6 years ; 19.5 % male ) , the most prevalent directive was DNR ( 89.3 % ) and foregoing antibiotics was least common ( parenteral , 8.2 % ; any type , 4.0 % ) . Concordance between directives and each level of care preference was as follows : comfort , 7 % ; basic , 49 % ; and intensive , 58 % . When comfort care was preferred , concordance was higher in intervention versus control facilities ( 10.8 % vs. 2.5 % ; adjusted odds ratio , 2.48 ; 95 % CI , 1.01 - 6.09 ) . CONCLUSION Better alignment between preferences for comfort-focused care and advance directives is needed in advanced dementia . An ACP video may help achieve that goal
OBJECTIVE The purpose of this study is to explore the evidence surrounding educational videos for patients and family caregivers in hospice and palliative care .
We ask three research questions : 1 .
What is the evidence for video interventions ?
2 .
What is the quality of the evidence behind video interventions ?
3 .
What are the outcomes of  video interventions ?