In a pivotal study by Harvard Medical School and Massachusetts General Hospital researchers, funded by the NIA and published in JAMA Network Open, it was found that video interventions administered by palliative care educators notably improved the dialogue and recorded preferences for care among elderly inpatients. This research broadened the examination of an existing collection of concise, evidence-informed videos, crafted in unambiguous language, which assists hospital patients in understanding the breadth of care options during serious illnesses. Additionally, it enables patients to more effectively express their care objectives to both medical personnel and relatives.
Crafted to surpass traditional means such as pamphlets or oral briefings by hospital representatives, this digital library comprises narrated portrayals of challenging conversations regarding care choices that patients and their families often face. These include discussions around end-of-life procedures like cardiopulmonary resuscitation for patients, or the contemplation of palliative care or hospice for those in advanced stages of Alzheimer’s disease or similar dementias. Accessible in 29 languages, the goal-of-care videos are displayed to patients on tablet devices and can be electronically forwarded to caregivers who are managing from a distance, ensuring connectivity even in cases where in-person visits are curtailed by COVID-19 or other infectious conditions, or if the patient is unable to communicate.
Historically, many patients have neglected to converse about medical care preferences with their physicians or family until it’s too late, due to cultural barriers, anxieties, or time constraints. This avoidance often leaves the tough calls to relatives or caregivers amidst urgent situations or when the patient is incapacitated or requires artificial ventilation.
The referenced study spanned from July 1, 2021, to October 31, 2022, and involved 10,802 senior adults from two metropolitan hospitals in New York and Boston. They were divided into two factions: one experienced the Goal of Care (GOC) video intervention dispensed by palliative care educators – a team of social workers and nurses adept in palliative guidance and GOC dialogue – while the other proceeded with standard care.
Results were telling. In the video intervention collective, 62.2% had their GOC meticulously chronicled, overshadowing the 50.1% in the standard care group. This was particularly significant among demographics traditionally less likely to have this documentation: Black patients (62.9% vs. 53%), Hispanic patients (56.8% vs. 48.3%), non-English speaking individuals (55.3% vs. 46.9%), and those with Alzheimer’s or related dementias (76.4% vs. 62.3%).
The investigators surmised that the video approach could indeed be a vital tool for decision-making support for patients and their families, potentially conserving critical hospital staff time and assets while bestowing autonomy to patients or their proxies. They noted, however, that the study was limited by its short-term intervention rather than enduring GOC discussions. Their ambition is to expand the application of this video tool to various healthcare environments, including ambulatory care.