CPR Video Improves Decision-Making in Advanced Cancer

Kate O'Rourke

October 13, 2015

BOSTON — Use of a video to explain cardiopulmonary resuscitation (CPR) was useful in educating seriously ill patients with cancer about the risks and benefits of the procedure and helped to inform their choices about end-of-life care, say researchers reporting a randomized trial that compared patients who watched the video with patients receiving standard care.

"Patients with advanced cancer who watched a CPR video decision support tool were more likely not to want CPR and were better informed about their options," said lead author Areej El-Jawahri, MD, an oncologist at Massachusetts General Hospital, Harvard Medical School, Boston. While physicians usually use words to describe medical interventions, verbal descriptions are limited and video can offer more realistic and accurate images and expectations about medical procedures, according to Dr El-Jawahri, who presented the study at the recent Palliative Care in Oncology Symposium (PCOS) 2015.

In the clinical trial, conducted at Stanford University and Massachusetts General Hospital, 116 hospitalized patients with advanced cancer were randomly assigned to a group that watched a 3-minute video describing CPR (n = 52) or a group that received standard oncology care (n = 64). At baseline and after the intervention, patients were asked whether they wanted to have CPR if they needed it and were allowed to answer "yes," "no," or "unsure."

Before randomization, the answers were similar in both groups: 63% of patients in the video group and 58% in the control group answered yes, and 6% vs 8% answered that they were unsure.

After randomization, patients who watched the video were much more likely than the control group to respond that they didn't want CPR (81% vs. 58%; P = .03) and were less likely to respond that they were unsure about what they wanted (4% vs 8%; P = .03).

At the end of the trial, the two groups were also asked five questions and scored 1 point for each question that was answered correctly. The average knowledge score was higher in the video intervention group (4.3 vs. 3.2; P < .001). Almost 100% of patients in both groups responded correctly to the statement, "CPR is a medical procedure that is done on patients in an attempt to restart their heart." Patients in the video intervention group were also more likely to respond correctly to the other four items:

  1. Most patients with advanced cancer who get CPR in the hospital survive and get to leave the hospital (False).

  2. Most patients with advanced cancer who have CPR have very few complications from these procedures (False).

  3. All patients with advanced cancer who get CPR or are placed on a breathing machine are taken care of in intensive care (True).

  4. How many seriously ill patients who get CPR in the hospital survive and get to go home: a few (Correct), almost all, or about half?

Individuals who watched the video reported feeling comfortable watching the video, and most would recommend it to others facing similar decisions.

Table. Patients' Impressions of CPR Video

Question Response
How helpful was the video? Very (27%), somewhat (54%), a little (13%), not (6%)
Would you recommend the video? Definitely (64%), probably (31%), probably not (4%), definitely not (1%)
How comfortable were you watching the video? Very (73%), somewhat (21%), not (6%)

 

Timothy Moynihan, MD, an associate professor of oncology at the Mayo Clinic, Rochester, Minnesota, told Medscape Medical News that the data clearly show that the videos can assist or at least alter patient decisions.

"The big challenge is that these short videos have to counter the hours and hours of unrealistic videos on TV and movies that show everyone recovering and walking out of the hospital, while we know that actually happens in less than 3% of cases," said Dr Moynihan. "The second point is that the video must be accompanied by a face-to-face discussion (probably both before and after a patient views the video), so the clinician can place the information in the proper context for the individual patient. This [video] can be a useful tool to add to each clinician's tool box to facilitate communication, but should not replace conversation."

Daniel Hinshaw, MD, professor of surgery, University of Michigan, and a member of the palliative care program at the Veterans Administration Ann Arbor Health Care System Medical Center, agreed that videos could be helpful in educating patients about end-of-life issues. "The old adage, a picture is worth a thousand words, comes to mind," Dr Hinshaw told Medscape Medical News.

"I think defining the context in which the films are viewed is of critical importance. Preferably, they should be viewed when the patients are not in the 'heat of battle' but are feeling relatively well. Rational arguments in my experience don't go very far when emotions are high. Presenting a video under urgent circumstances may be perceived as coercive. It should be noted that films, of course, also affect emotions, so that they can influence decision-making in not purely rational ways."

Dr El-Jawahri, Dr Moynihan, and Dr Hinshaw have disclosed no relevant financial relationships.

Palliative Care in Oncology Symposium (PCOS) 2015. Abstract 7. Presented October 9, 2015.

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