Randomized controlled trial of a video decision support tool for cardiopulmonary resuscitation decision making in advanced cancer. A randomized controlled trial of a cardiopulmonary resuscitation video in advance care planning for progressive pancreas and hepatobiliary cancer patients. A randomized controlled trial of a goals-of-care video for elderly patients admitted to skilled nursing facilities. Brief DVD-based educational intervention for patients with cancer pain: feasibility study Hospice experiences and approaches to support and assess family caregivers in managing medications for home hospice patients: A providers survey Using Video Discharge Instructions as an Adjunct to Standard Written Instructions Improved Caregivers’ Understanding of Their Child’s Emergency Department Visit, Plan, and Follow-Up: A Randomized Controlled Trial
PURPOSE Decision making regarding cardiopulmonary resuscitation ( CPR ) is challenging . This study examined the effect of a video decision support tool on CPR preferences among patients with advanced cancer . PATIENTS AND METHODS We performed a r and omized controlled trial of 150 patients with advanced cancer from four oncology centers . Participants in the control arm ( n = 80 ) listened to a verbal narrative describing CPR and the likelihood of successful resuscitation . Participants in the intervention arm ( n = 70 ) listened to the identical narrative and viewed a 3-minute video depicting a patient on a ventilator and CPR being performed on a simulated patient . The primary outcome was participants ' preference for or against CPR  measured immediately after exposure to either modality . Secondary outcomes were participants ' knowledge of CPR ( score range of 0 to 4 , with higher score indicating more knowledge ) and comfort with video . RESULTS The mean age of participants was 62 years ( st and ard deviation , 11 years ) ; 49 % were women , 44 % were African American or Latino , and 47 % had lung or colon cancer . After the verbal narrative , in the control arm , 38 participants ( 48 % ) wanted CPR , 41 ( 51 % ) wanted no CPR , and one ( 1 % ) was uncertain . In contrast , in the intervention arm , 14 participants ( 20 % ) wanted CPR , 55 ( 79 % ) wanted no CPR , and 1 ( 1 % ) was uncertain ( unadjusted odds ratio , 3.5 ; 95 % CI , 1.7 to 7.2 ; P < .001 ) . Mean knowledge scores were higher in the intervention arm than in the control arm ( 3.3 ± 1.0 v 2.6 ± 1.3 , respectively ; P < .001 ) , and 65 participants ( 93 % ) in the intervention arm were comfortable watching the video . CONCLUSION Participants with advanced cancer who viewed a video of CPR were less likely to opt for CPR than those who listened to a verbal narrative 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 To determine the impact of a video on preferences for the primary goal of care . DESIGN , SUBJECTS , AND INTERVENTION Consecutive subjects 65 years of age or older ( n=101 ) admitted to two skilled nursing facilities ( SNFs ) were r and omized to a verbal narrative ( control ) or a video ( intervention ) describing goals -of-care options . Options included : life-prolonging ( i.e. , cardiopulmonary resuscitation ) , limited ( i.e. , hospitalization but no cardiopulmonary resuscitation ) , or comfort care ( i.e. , symptom relief ) . MAIN MEASURES Primary outcome was patients ' preferences for comfort versus other options . Concordance of preferences with documentation in the medical record was also examined . RESULTS Fifty-one subjects were r and omized to the verbal arm and 50 to the video arm . In the verbal arm , preferences were : comfort , n=29 ( 57 % ) ; limited , n=4 ( 8 % ) ; life-prolonging , n=17 ( 33 % ) ; and uncertain , n=1 ( 2 % ) . In the video arm , preferences were : comfort , n=40 ( 80 % ) ; limited , n=4 ( 8 % ) ; and life-prolonging , n=6 ( 12 % ) . R and omization to the video was associated with greater likelihood of opting for comfort ( unadjusted rate ratio , 1.4 ; 95 % confidence interval [ CI ] , 1.1 - 1.9 , p=0.02 ) . Among subjects in the verbal arm who chose comfort , 29 % had a do-not-resuscitate ( DNR ) order ( κ statistic 0.18 ; 95 % CI-0.02 to 0.37 ) ; 33 % of subjects in the video arm choosing comfort had a DNR order ( κ statistic 0.06 ; 95 % CI-0.09 to 0.22 ) . CONCLUSION Subjects admitted to SNFs who viewed a video were more likely than those exposed to a verbal narrative to opt for comfort . Concordance between a preference for comfort and a DNR order was low . These findings suggest a need to improve ascertainment of patients ' preferences . TRIAL REGISTRATION Clinical trials.gov Identifier : NCT01233973 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 Background : Hospice providers need to ensure that informal , unpaid caregivers can safely manage medications to alleviate pain and distressing symptoms in patients near the end of life . Aim : This study characterizes hospice providers ’ self-reported experiences and approaches to helping caregivers ’ medication management for home hospice patients . Design : Survey with mixed- method analysis . Setting / Participants : Surveys were administered to a convenience sample of 98 hospice providers ( 74 nurses , 6 physicians , 11 social workers , 7 chaplains ) from 5 Chicago-based agencies in the United States . Results : Among respondents , 67 % rated ensuring proper medication management as “ most important ” in hospice care delivery , and 33 % reported frequently encountering caregivers with problems managing medications . To assess if caregivers had problems managing medications , two categories of approaches emerged from the data : prospect i ve approaches and retrospective warning signs when a problem occurred ( e.g. identifying medication nonadherence after observing a sudden patient health decline ) . Overall , 42 % reported using at least one prospect i ve approach , while 38 % reported only retrospective signs . To help caregivers manage medications , three categories of approaches emerged : teaching to increase knowledge , supporting existing or simplifying medication management process , and counseling to overcome attitudinal barriers . Overall , 6 % reported approaches from all three categories . About 28 % frequently experienced difficulty teaching/supporting caregivers with medication management . As much as 47 % believed that they would benefit “ to a great extent ” from additional re sources to help caregivers . Conclusions : Supporting caregivers in medication management is considered important , yet challenging , to hospice providers . Additional re sources may be needed to help providers consistently and effectively teach , support , and assess caregivers ’ medication management Objective Previous studies demonstrate that patients often have difficulty underst and ing their discharge instructions . Video discharge instructions have the potential to mitigate factors such as illiteracy and limited physician time , which may affect comprehension . Our goal is to determine if adding video discharge instructions affects caregivers ’ underst and ing of their child ’s emergency department ( ED ) visit , plan , and follow-up . Methods Caregivers of patients , aged 29 days to 18 years , with a diagnosis of fever , vomiting or diarrhea , and wheezing or asthma were r and omized into written or video discharge instruction groups . In the ED , caregivers read st and ard written discharge instructions or watched a 3-minute video based on their child ’s diagnosis . They were then asked questions regarding information covered in these instructions . After completing the 20-point question naire , st and ard discharge procedure was followed . Caregivers were contacted by phone 2 to 5 days after discharge for a follow-up question naire . Usefulness of the discharge instructions was also assessed . Results Of 436 caregivers enrolled , 220 received written and 216 received video discharge instructions .  The follow-up question naire was completed by 341 caregivers . The group receiving video discharge instructions  scored significantly higher in the ED ( 12.2 vs 8.9 ) and 2 to 5 days after discharge ( 11.1 vs 7.8 ) . At follow-up , 29 % of the written and 42 % of the video groups rated their discharge instructions as being extremely helpful . Conclusions Brief video discharge instructions improved caregiver knowledge both in the ED and 2 to 5 days after discharge compared with written discharge instructions alone . Caregiver satisfaction with video discharge instructions was also greater than with written discharge instructions
CONTEXT Cancer caregivers have information and support needs , especially about cancer pain management .
With high Internet use reported among caregivers , YouTube may be an accessible option when looking for information on cancer pain management .
OBJECTIVES The purpose of this study was to explore the availability and characteristics of instructional cancer pain management videos on YouTube and determine to what extent these videos addressed the role of informal caregivers in cancer pain management .