Cancer Control Research5R21CA139121-02
USING VIDEO IMAGES TO IMPROVE ADVANCE CARE PLANNING IN PATIENTS WITH CANCER
DESCRIPTION (provided by applicant): One of the most difficult decisions to be made for cancer patients at the end of life is whether or not to pursue life-sustaining treatment. Both physicians and the public have shown a heightened interest in advance care planning (ACP) since cancer patients need to become increasingly involved in the clinical decision-making process. Video is an underutilized medium that can assist clinicians in end-of-life discussions of the goals of care. Video may enable patients to visualize the future by concisely providing complex information vital for ACP. This study will examine whether the use of video could facilitate a more comprehensive understanding of the goals of care for terminal cancer patients. Video decision aids may inform clinician-patient discussions about the level of care cancer patients would want at the end of life. We propose to conduct a before-and-after trial to examine whether a video decision aid of the goals of care could shape the choices made by terminal cancer subjects about the kind of care they would want in the future. Specific aim 1 is to assess the effect of a video decision aid on the clinical decision-making of terminal cancer subjects. Specific aim 2 is to assess the effects of the video on decisional conflict of subjects. And, specific aim 3 is to study predictors of goals of care. The primary outcome is change in preferences for level of medical care after viewing the video. A secondary outcome is change in decisional conflict after viewing the video. Evaluate whether a video decision aid can serve as a prototype for other common end-of-life diseases that involve difficult decisions regarding whether or not to pursue life-sustaining treatment. Public Health Relevance: Treatment decisions at the end of life for cancer patients are some of the most difficult decisions confronting medicine. Both physicians and the public have shown a heightened interest in advance care planning (ACP) to help clinical decision-making. Our study explores the use of video in assisting ACP discussions for patients with terminal cancer. The present work of using video in ACP discussions in the context of cancer will serve as a prototype for other common diseases that involve difficult decisions.