March 25, 2013 11:22 am
Everyone knows that videos can help you live better: how else would we enjoy so many awesome cat moments? But one group of doctors think that simply watching a video could help people die better, too.
There’s a three-minute video that can change the way you die. It shows a group of doctors crowded around a mannequin, pushing down on its chest, placing a tube down its throat. It cuts to an unconscious elderly person in a hospital bed, tethered to machines by the mouth and the veins. “Frequently, CPR does not work,” the female narrator calmly explains, and those who survive are often sedated through IV and placed on a ventilator which prevents eating and talking.
Advanced cancer patients who watched this video in their oncologists’ office were over 50 percent more likely to say they did not want CPR attempted on them, compared to a group of similar patients who heard only a verbal version of the same information. The study, published in January in the Journal of Clinical Oncology, is the latest in a string of trials led by Angelo Volandes examining how informational videos influence patients’ preferences about treatment at the end of life.
Volandes has made all sorts of videos about end of life care, in an attempt to portray measures like CPR more accurately. Since most of us don’t see emergency medicine all that often, we tend to have an unrealistic idea about just how successful these sorts of interventions are. On television, 77 percent of patients who are given CPR live. In the hospital, it’s a different story:
Although more than 40 percent of cancer patients undergoing in-hospital CPR survive the event, most never go home again. Only six in 100 cancer patients are actually discharged from the hospital following CPR, according to a 2006 meta-analysis of 42 studies. For patients with localized disease, the survival rate was higher: 9.5 percent, compared to 5.6 percent for patients with metastatic cancer.
Here’s an oddly shot video of Volandes presenting his ideas:
Volandes also presented his work at South By Southwest last year, writing in his talk’s description:
A key ingredient to informed patient-doctor discussions regarding end-of-life care includes the patient’s ability to understand and imagine hypothetical disease states and medical interventions like CPR. However, studies suggest that there are numerous barriers to communication between doctors and patients. One innovation to surmount these barriers includes using video decision aids to reinforce end-of-life conversations.
Not everyone agrees with Volandes’s approach of course. Here’s Scienceline again:
Physicians asked to weigh-in on the studies appreciated the problem Volandes is trying to tackle, but some weren’t enthusiastic about using the videos themselves. “It may not be appropriate for most patients, frankly,” said Maria Silveira, who practices general medicine and palliative care at the University of Michigan Medical Center. She said that doctors who have established, trusting relationships with their patients wouldn’t need to use a video aid. “Really these videos came into being – this is only my opinion – for the purposes of helping people decide to refuse this care.”
Of course, Volandes doesn’t see it that way. He wrote an op-ed for the Boston Globe describing why, and how he came to this way of thinking about things. After speaking with patient after patient about dying, end of life care and the various treatments and interventions and machines they might encounter, Volandes decided there should be a better way. He writes:
I, along with a loose network of 100 physicians, patients, and families from around the country, have created a library of digital videos to better inform patients about their medical options as they approach the end of life. We have created videos for all the leading causes of death — including heart disease and dementia — and have tailored the videos for each disease. Video decision aids empower patients with the knowledge needed to make informed decisions by providing the facts about medical care and standardizing the information patients need to know. All the videos undergo a rigorous review process and provide a balanced review of options for patients and families.
Most people can agree that patient care at the end of life, especially in the United States, is broken. The question really is how to fix it.
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