Due to advances in life-prolonging technologies, growing numbers of patients are living with advanced heart disease, increasing the population of patients who need to communicate their preferences for future medical care to their physicians. Patients with advanced heart disease must make crucial decisions impacting the length and quality of their lives. Advance Care Planning (ACP) is the process by which patients plan for future medical care in the event of impaired decision-making. Informed ACP can be a complex process. It is very difficult to realistically envision future care solely with verbal or written descriptions. Video is an under-utilized medium that can enhance verbal and written approaches to ACP by providing realistic and easily understandable visual images of care to improve understanding and communication between patients and physicians. We have developed an experimental approach that uses video images of medical interventions to better inform patients about their options for future medical care. We have successfully tested this approach in patients with cancer and dementia. RESEARCH PLAN: We propose to conduct a randomized controlled trial of subjects with advanced heart failure to examine whether a video decision aid of the goals of care could shape the choices made by advanced heart failure 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 advanced heart failure subjects as compared to a verbal description.
Specific aim 2 is to assess the effects of the video on knowledge and decisional conflict of subjects.
Specific aim 3 explores the effects of the video after one year. And, Specific aim 4 uses qualitative methods to explore subjects'beliefs and attitudes about heart failure. The primary outcome is whether or not subjects would want life-prolonging interventions attempted at the end of life in the two arms of the study. FUTURE DIRECTIONS: Evaluate whether a video decision aid can serve as a prototype for other common advanced diseases that involve difficult decisions regarding whether or not to pursue life-sustaining treatment.

Public Health Relevance

Whether or not to have medical interventions attempted in the future for patients with advanced heart failure includes some of the most difficult decision-making confronting patients. Both physicians and the public have shown a heightened interest in advance care planning to help clinical decision-making. Our study explores the use of video decision aids in assisting discussions between patients with advanced heart failure and their physicians. The present work of using video decision aids in advance care planning discussions in the context of heart failure will serve as a prototype for other common diseases that involve difficult decisions.

National Institute of Health (NIH)
National Heart, Lung, and Blood Institute (NHLBI)
Research Project (R01)
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Behavioral Medicine, Interventions and Outcomes Study Section (BMIO)
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Cooper, Lawton S
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Massachusetts General Hospital
United States
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El-Jawahri, Areej; Paasche-Orlow, Michael K; Matlock, Dan et al. (2016) Randomized, Controlled Trial of an Advance Care Planning Video Decision Support Tool for Patients With Advanced Heart Failure. Circulation 134:52-60