A new study suggests that elderly patients are able to make more informed decisions about their "end-of-life" care after viewing a video showing a patient with advanced dementia.
The researchers believe that providing seniors with actual visual images of what life with dementia is like helps them to understand complex health information and to think about how they would want to be cared for in their final days.
The study involved 200 healthy people aged 65 years and older who were interviewed about their health and scored on their knowledge of advanced dementia.
They were randomly split into two groups:
- One listened to a seminar describing advanced dementia
- The other listened to the same seminar followed by watching a two-minute video of a patient with advanced dementia
Participants were then interviewed afterwards about their knowledge of advanced dementia and their preferences for goals of end-of-life care.
The seniors could choose from one of three options: life-prolonging care, which would mean prolonging life at any cost; limited care, which would aim to maintain physical functioning; and comfort care, which aims to maximize comfort and to relieve pain.
Among the 106 patients receiving only the seminar 64 per cent chose comfort care compared to 86 per cent who saw the video and heard the seminar.
Those the video group also scored higher in testing of their knowledge about life with advanced dementia, compared to the control group.
What's more, the video group was more likely to remain consistent in their decisions over time. When the participants were contacted again after six weeks to see whether their preferences had changed, 29 per cent of the seminar-only group changed their minds, while only six per cent in the video group changed their plans.
"Education of patients using video decision support tools can improve their comprehension of disease states such as advanced dementia that are difficult to envision solely with words," the authors conclude in the study, published online on BMJ.com.
Video makes it real
Dr. Angelo Volandes of Massachusetts General Hospital says he conducted the study because he knows that for many seniors, discussions about end-of-life care can be complex and abstract.
"I'm a physician and I have these conversations with my elderly patients all the time," he told Canada AM from Boston Friday.
"I realized that when we use words like dementia and CPR, what physicians mean by it and what patients imagine those interventions to be are two very different things. Most patients' understanding is reflective of the latest TV show than of the clinical reality. Video makes it real. And video empowers patients to make more informed decisions."
He says most of the people in the group didn't shy away from the topic of discussing their dying years; they welcomed the discussion.
"They were very comfortable watching the video, which I think is something that surprised a lot of people," Volandes said.
"Most importantly, when we asked patients would they recommend the video to others who are also making these decisions, the vast majority would suggest that others watch the video -- which speaks to the adage that a picture is worth 1,000 words."
"This is just additional tools for health care professionals to use to educate out patients.
We don't want patients to just make decisions; we want to make sure those decisions are informed so that we, as practitioners, can empower them and advocate on their behalf."
Volandes says his team is now extending the concept of using videos to educate patients into other conditions besides dementia.
"We're presently conducting a study in advanced cancer patients who are making decisions on CPR. We created a video of CPR and we showed patients what it means to be on a breathing machine or ventilator. And we're also doing similar studies on patients with heart failure and pulmonary disease."
