Nav: Home

Video messages clarify patients' wishes for critical versus end-of-life care

February 16, 2017

February 16, 2017 - Adding a patient-created video testimonial to a living will or "POLST" form can help to prevent errors of interpretation regarding the choice between life-sustaining treatment or allowing natural death in critically ill patients, according to a study in the March Journal of Patient Safety. The journal is published by Wolters Kluwer.

"Interpretation errors are common with living wills and POLST forms," commented Dr. Ferdinando L. Mirarchi of University of Pittsburgh Medical Center (UPMC) Hamot, in Erie, Pa., lead author of the new report. "Our study shows that medical professionals are more likely to reach a consensus after viewing a video testimonial, proving that we can do better than paper forms alone."

Video Testimonials Improve Consensus Regarding Patients' Wishes

Written documents such as living wills (LWs) seek to direct medical treatments in the event the patient loses decision-making capacity. A newer type of document--called Physician Orders for Life-Sustaining Treatment, or POLST--provides a one-page format for seriously ill patients to indicate their treatment preferences.

"Both living wills and POLST are very much needed and effective," Dr. Mirarchi explained. "However, they are prone to medical errors related to provider misinterpretation of what is documented and appropriate patient selection." He notes three ways in these medical errors can cause harm: by taking a life inappropriately, by preventing the natural dying process, or by leading to overuse of costly medical resources.

In a nationwide internet survey, 741 physicians at 13 hospitals were presented with clinical scenarios involving critically ill patients who had either an LW or POLST. Doctors were randomly assigned to interpret the patients' wishes based on the LW or POLST alone, or with the addition of a scripted video testimonial in which patients talked about their treatment choices.

Responses were compared to see if the video testimonials led to more accurate interpretation of the patient's intentions. Choices included full aggressive treatment including CPR; aggressive care with a brief attempt at CPR; or no CPR/'allow natural death.'

The results suggested that doctors reached a higher level of agreement in interpreting the patients' wishes when they viewed the video testimonials. Based on the LW or POLST documents only, doctors reached a consensus (95 percent agreement) in two out of nine clinical scenarios.

Adding the video testimonials produced statistically significant changes in the responses of seven scenarios--in five of these, physicians were more likely to choose full aggressive treatment. Overall, the addition of a video testimonial was the most consistent predictor of resuscitation choices achieving interpretive consensus.

While end-of-life treatment should be predicated on consensus understanding of patient wishes, there is concern about how LW or POLST documents might affect patient-centered, medical decision making. Previous studies have raised questions as to how well medical providers understand these documents--including the simplified POLST form. Twenty-six states have adopted the POLST or similar forms so far, and that number is expected to increase.

At present both LWs and POLST forms "fail the litmus test" of achieving consensus among physicians, the results suggest. "Video testimonials can ensure the safe interpretation of LWs and POLST documents and ensure that these documents are faithful to the wishes and goals of the patient producing benefits for all stakeholders in the health care system," Dr. Mirarchi and colleagues conclude.

The study also raises concerns related to medical provider bias with respect to chronically ill or disabled people who have an LW or POLST. "This population should be carefully managed and researched to ensure their safety and decision making," Dr. Mirarchi commented.
-end-
Click here to read "TRIAD VIII: Nationwide Multicenter Evaluation to Determine Whether Patient Video Testimonials Can Safely Help Ensure Appropriate Critical Versus End-of-Life Care."

Article: "TRIAD VIII: Nationwide Multicenter Evaluation to Determine Whether Patient Video Testimonials Can Safely Help Ensure Appropriate Critical Versus End-of-Life Care" (doi: 10.1097/PTS.0000000000000357)

About Journal of Patient Safety

Journal of Patient Safety is dedicated to presenting research advances and field applications in every area of patient safety. While Journal of Patient Safety has a research emphasis, it also publishes articles describing near-miss opportunities, system modifications that are barriers to error, and the impact of regulatory changes on healthcare delivery. This mix of research and real-world findings makes Journal of Patient Safety a valuable resource across the breadth of health professions and from bench to bedside.

About Wolters Kluwer

Wolters Kluwer is a global leader in professional information services. Professionals in the areas of legal, business, tax, accounting, finance, audit, risk, compliance and healthcare rely on Wolters Kluwer's market leading information-enabled tools and software solutions to manage their business efficiently, deliver results to their clients, and succeed in an ever more dynamic world.

Wolters Kluwer reported 2015 annual revenues of €4.2 billion. The group serves customers in over 180 countries, and employs over 19,000 people worldwide. The company is headquartered in Alphen aan den Rijn, the Netherlands. Wolters Kluwer shares are listed on Euronext Amsterdam (WKL) and are included in the AEX and Euronext 100 indices. Wolters Kluwer has a sponsored Level 1 American Depositary Receipt program. The ADRs are traded on the over-the-counter market in the U.S. (WTKWY).

Wolters Kluwer Health is a leading global provider of information and point of care solutions for the healthcare industry. For more information about our products and organization, visit http://www.wolterskluwer.com, follow @WKHealth or @Wolters_Kluwer on Twitter, like us on Facebook, follow us on LinkedIn, or follow WoltersKluwerComms on YouTube.

Wolters Kluwer Health

Related Decision Making Articles:

Shared decision-making is cornerstone of multiple sclerosis treatment
One of the cornerstones of multiple sclerosis treatment is shared decision-making between patients and their doctors and nurses, according to a report in the journal Practical Neurology.
Calcium dynamics regulating the timing of decision-making in C. elegans
All animals make decisions according to information, but the detailed mechanism is not known.
Wide variability in coroner decision-making around investigating deaths
Coroners in England and Wales don't seem able to agree on what caused a person's death or whether the death merits an inquest or not -- despite being faced with identical case information -- reveals a small study published online in the Journal of Clinical Pathology.
OU study clarifies risky decision making during a heart attack
In a recent study to determine why some individuals who experience symptoms for acute coronary syndrome decide to seek medical attention more quickly than others, a University of Oklahoma researcher has identified numeracy -- the ability to understand and apply numerical concepts as the primary decision delay risk factor for individuals experiencing the medical condition.
Decision-making process of viruses could lead to new antibiotic treatments
Humans face hundreds of decisions every day. But we're not alone.
A new prognostic classification may help clinical decision-making in glioblastoma
New research shows that taking molecular variables into account will improve the prognostic classification of the lethal brain cancer called glioblastoma (GBM).
Here's when powerful people have trouble making a decision
Although powerful people often tend to decide and act quickly, they become more indecisive than others when the decisions are toughest to make, a new study suggests.
Compromise nearly guaranteed when a woman is involved in decision-making pairs
Compromise always occurs among two decision makers when a woman is involved (female pairs or mixed gender pairs) because compromise is consistent with feminine norms.
Counteracting poor decision-making due to sleep loss
Researchers from Washington State University's Sleep and Performance Research Center received a $1.7 million grant to develop and test cognitive flexibility training to combat the effects of sleep loss on decision-making under rapidly changing circumstances.
Circuit for experience-informed decision-making ID'd in rats
Researchers have discovered how the rat brain 's memory and executive hubs talk with each other as decision-making is informed by past experiences.

Related Decision Making Reading:

Best Science Podcasts 2019

We have hand picked the best science podcasts for 2019. Sit back and enjoy new science podcasts updated daily from your favorite science news services and scientists.
Now Playing: TED Radio Hour

Setbacks
Failure can feel lonely and final. But can we learn from failure, even reframe it, to feel more like a temporary setback? This hour, TED speakers on changing a crushing defeat into a stepping stone. Guests include entrepreneur Leticia Gasca, psychology professor Alison Ledgerwood, astronomer Phil Plait, former professional athlete Charly Haversat, and UPS training manager Jon Bowers.
Now Playing: Science for the People

#524 The Human Network
What does a network of humans look like and how does it work? How does information spread? How do decisions and opinions spread? What gets distorted as it moves through the network and why? This week we dig into the ins and outs of human networks with Matthew Jackson, Professor of Economics at Stanford University and author of the book "The Human Network: How Your Social Position Determines Your Power, Beliefs, and Behaviours".