A Video to Improve Patient and Surrogate Understanding of Cardiopulmonary Resuscitation Choices in the ICU

Wilson, Michael E.; Krupa, Artur; Hinds, Richard; Litell, John M.; Swetz, Keith M.; Akhoundi, Abbasali; Kashyap, Rahul; Gajic, Ognjen; Kashani, Kianoush

doi:10.1097/ccm.0000000000000749

Cited by 50 publications

(59 citation statements)

References 34 publications

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“…7,12,13,14,15 Previous efforts to improve surrogate decision making have largely been directed towards improving surrogates’ understanding of medical facts and the cognitive quality of their decisions. 16,17,18,19 or towards improving the accuracy of their substituted judgments. 20,21 These studies have had negligible success.…”

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confidence: 99%

The Trial of Ascertaining Individual Preferences for Loved Ones' Role in End-of-Life Decisions (TAILORED) Study: A Randomized Controlled Trial to Improve Surrogate Decision Making

Sulmasy

Hughes

Yenokyan

et al. 2017

Journal of Pain and Symptom Management

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Context Patients with terminal illnesses often require surrogate decision makers. Prior research has demonstrated high surrogate stress, and that despite standards promoting substituted judgment, most patients do not want their surrogates to make pure substituted judgments for them. It is not known how best to help loved ones fulfill the surrogate role. Objectives To test the effectiveness of an intervention to help surrogate decision makers. Methods 166 patients (41% with ALS and 59% with gastrointestinal cancers) and their surrogates at 2 university medical centers were randomized to an intensive nurse-directed discussion of the end of life Decision Control Preferences of the patient (TAILORED) or a discussion of nutrition (CONTROL); 163 completed baseline interviews and underwent the intervention. Results Twelve patients died during follow-up and 137 dyads completed the study. Post-intervention, using all available data, TAILORED patients and surrogates became more likely to endorse mutual surrogate decision making, i.e., a balance of their own wishes and what the surrogate thinks best (Adjusted odds compared with baseline for patients = 1.78, p = .04; Adjusted odds for surrogates = 2.05, p = .03). CONTROL patients became 40% less likely to endorse mutual surrogate decision making (p = 0.08) while CONTROL surrogates did not change significantly from baseline (adjusted odds = 1.44, p = .28). Stress levels decreased for TAILORED surrogates (Impact of Events Scale = 23.1±14.6 baseline, 20.8±15.3 f/u, p= 0.046), but not for CONTROL (p = .85), and post-intervention stress was lower for TAILORED than CONTROL (p = .04). Surrogate confidence was uniformly high at baseline and did not change. Caregiver burden (Zarit) increased from 12.5±6.5 to 14.7±8.1 for TAILORED (p <.01) while not changing for CONTROL, yet satisfaction with involvement in decision making was higher at follow-up for TAILORED than for CONTROL (71% vs. 52%, p = .03). Conclusion TAILORED patients and surrogates who completed the study adopted a more mutual decision making style, balancing their own wishes with what the surrogate thinks would be best for them. Surrogates reported less stress and more satisfaction. Confidence was high at baseline and did not change. There was a modest increase in caregiver burden. These findings suggest that interventions like TAILORED might positively impact surrogate decision making.

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confidence: 99%

The Trial of Ascertaining Individual Preferences for Loved Ones' Role in End-of-Life Decisions (TAILORED) Study: A Randomized Controlled Trial to Improve Surrogate Decision Making

Sulmasy

Hughes

Yenokyan

et al. 2017

Journal of Pain and Symptom Management

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“…The use of multimedia educational tools, including both written material and video, may address limitations of written and visual information when each is used in isolation. As in this study and in others assessing the ability of video to enhance knowledge, the combination of video and written information, when well-designed, can improve patient and surrogate understanding of medical information [2, 4–6]. …”

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confidence: 70%

“…Unfortunately, deficiencies in CPR education are abundant [1]. In this issue of Critical Care Medicine , Wilson and colleagues [2] evaluate the role of a video to improve patient and surrogate understanding of CPR choices in the intensive care unit (ICU).…”

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confidence: 99%

Enhancing Informed Decision Making

Long

Curtis

2015

Critical Care Medicine

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“…In addition to new types of written materials, we recognize that many patients want access to health education materials in nonwritten formats. For example, presenting information in a video format may be associated with improved knowledge (47). However, the quality and accessibility of these media are inconsistent (30), and although there has been an explosion in the number of apps for patients with asthma, their quality is variable, and the ability to improve outcomes is unknown (48,49).…”

mentioning

confidence: 99%

Improving Health Literacy. The New American Thoracic Society Guidelines for Patient Education Materials

Slatore¹,

Kulkarni

Corn

et al. 2016

Annals ATS

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A Video to Improve Patient and Surrogate Understanding of Cardiopulmonary Resuscitation Choices in the ICU

Cited by 50 publications

References 34 publications

The Trial of Ascertaining Individual Preferences for Loved Ones' Role in End-of-Life Decisions (TAILORED) Study: A Randomized Controlled Trial to Improve Surrogate Decision Making

The Trial of Ascertaining Individual Preferences for Loved Ones' Role in End-of-Life Decisions (TAILORED) Study: A Randomized Controlled Trial to Improve Surrogate Decision Making

Enhancing Informed Decision Making

Improving Health Literacy. The New American Thoracic Society Guidelines for Patient Education Materials

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