A Video Decision Aid for the West Virginia POST: A Randomized, Controlled Trial

Abstract

Patients with serious medical conditions are faced with making decisions about treatments related to end-of-life care. The Physician Orders for Life Sustaining Treatment (POLST) is a document that allows patients to express preferences for four medical decisions including cardiopulmonary resuscitation, level of medical intervention, IV fluids, and feeding tubes. Although POLST paradigm forms are used throughout the United States, there is a lack of evidence about the quality of the decision-making process of individuals completing these forms. The use of a decision aid developed for the POLST paradigm could ensure that patients completing these forms are informed, confident, and certain of their treatment decisions. The purpose of the study was to develop and evaluate a video decision aid for the West Virginia POST form. 64 English-speaking, community-dwelling adults (50+), with no evidence of cognitive impairment, were recruited to participate in the study. Participants were randomized to active control (exercise video) or intervention groups (WV POST video). Participants were provided with a clinical vignette that contained medical information for the purpose of making treatment decisions and completing measures included in the study. Participants made decisions for each of the medical decisions contained in the WV POST and completed measures of knowledge, decisional conflict, and satisfaction at pre-and post-intervention. Preliminary analyses identified problems with multicollinearity and the satisfaction variable was removed from final analyses. Separate Multivariate Analysis of Covariance (MANCOVA) analyses were conducted to examine the effect of the video aid on post-intervention ratings of knowledge and decisional conflict, while controlling for numeracy and pre-intervention ratings of decisional outcomes. Chi-Square analyses were conducted to examine the relation between treatment group and participants' decisions for medical treatments. Results identified significant main effects of treatment group for each of the four medical decisions. At post-intervention, participants in the intervention group were more knowledgeable regarding CPR, medical interventions, and IV fluids compared to participants in the control group. Additionally, participants in the intervention group had less decisional conflict related to CPR, medical interventions, IV fluids, and feeding tubes, at post-intervention compared to participants in the control group. Participants who viewed the aid were more satisfied with their CPR, medical interventions, IV fluids, and feeding tube decisions than participants who did not view the aid. There was no significant association between group and medical decision made for any of the four medical decisions in the WV POST. These findings are important because it demonstrates the individuals can be taught necessary information to make an informed decision while completing the WV POST form, and that when using a decision aid, participants feel more informed and less uncertain about their decision. ...