People with advanced heart failure who watched a short video depicting different levels of end-of-life care were more likely to choose comfort care over invasive care that could prolong their lives, according to new research in the American Heart Association journal Circulation.
Patients who watched the video were also more knowledgeable about care levels and likely to discuss end-of-life care with their doctor — evidence that the goal to support, rather than replace, doctor-patient communication was being achieved.
“Because the course of heart failure is uncertain, in part because of improved therapies, doctors may be reluctant to initiate a conversation with their patients about advance care planning,” said Areej El-Jawahri, M.D., director of the bone marrow transplant survivorship program at Massachusetts General Hospital Cancer Center in Boston and a member of the Video Images of Disease for Ethical Outcomes (VIDEO) Consortium, in a press release.
“We found that when patients were better informed, it’s easier for them and their doctors to discuss end-of-life issues.”
Heart failure is a chronic condition in which the heart struggles to supply the body with enough blood to remain healthy. Those with advanced heart failure typically experience shortness of breath and fatigue with little or no activity, and their care often requires hospitalization.
In the study, 246 advanced heart failure patients from seven U.S. hospitals were given a verbal description of three levels of care they could receive at the end of their lives:
Life-prolonging care, including CPR and having a tube inserted into their windpipe and being placed on a breathing machine
Limited care, including intravenous therapy and hospitalization, but not CPR or a breathing machine
Comfort care, typically delivered at home with a focus on quality of life, but including hospitalization if required for symptom relief
Half of the participants were then randomly assigned to watch a six-minute video narrated by a physician with images depicting the three levels of care. Participants also received a checklist that encouraged them to discuss end-of-life care with their doctor.
51 percent of those who watched the end-of-life care video preferred comfort care, compared to 37 percent of those who didn’t see it;
68 percent of video viewers wanted to forgo CPR, compared to 35 percent of non-viewers;
77 percent of video viewers wanted to forgo a breathing machine, compared to 48 percent of non-viewers;
25 percent of video viewers chose limited care, compared to 22 percent of non-viewers;
2 percent of video viewers were uncertain of their preference, compared to 7 percent of non-viewers; and
61 percent of video viewers discussed their end-of-life choices with their physicians within three months, compared to 15 percent of non-viewers.