Multimedia decision support intervention: A promising approach to enhance the intention to complete an advance directive among hospitalized adults

Abstract

Purpose We examined the acceptability and initial efficacy of a multimedia decision support (MDS) intervention to improve intention to complete an advanced directive (AD) among hospitalized adults following an episode of critical illness. Data sources We used comparative quasi‐experimental posttest only design. Forty‐nine hospitalized adults, recovering from a critical illness, received either MDS or AD educational brochure. Demographic characteristics and self‐report measures of AD knowledge were captured at baseline and used as covariates. Helpfulness of the intervention (acceptability) and the outcome variable, intention to complete an AD decision, were assessed after exposure to the MDS intervention or educational brochure (information‐only control condition). Conclusions The MDS was a more acceptable form of education compared to a brochure. After adjusting for covariates, participants exposed to the MDS intervention were 24.7 times more likely to intend to complete an AD compared to those who were assigned to the information‐only control condition. Implications for practice This pilot study establishes the acceptability and initial efficacy of the MDS intervention among individuals with critical illness, who are at high risk for hospital readmission life‐sustaining treatment. This study illuminates a teachable moment in which patients are more receptive to interventions to complete an AD.

Tools to Promote Shared Decision Making in Serious Illness

“…Seven pilot trials tested ACP tools for future decisions, 15,23–27,34 and 14 tested tools to support patient engagement in current decisions. 7,16–22,28–33 Seven of the pilot trials 15–19,21,22 have been followed by published RCTs, 35–42 and a search of trial registries revealed that 2 additional studies 7,20 are being tested in clinical trials.…”

The Use of Health Information Technology to Improve Care and Outcomes for Older Adults

“…Hickman and colleagues created a multimedia decision support intervention that delivers education about advanced directives to patients recovering from critical illness (Hickman, Lipson, Pinto, & Pignatiello, 2013). Brought to the bedside via laptop computer, this intervention increased the intent to sign an advanced directive by 25 times compared to the commonly used advanced directive educational brochure, “Putting it in writing”.…”

A Hospital-Based Advance Care Planning Intervention for Patients with Heart Failure: A Feasibility Study

“…3 Prior research has found that the end-of-life care preferences of patients hospitalized with HF change over time 4 and after hospitalizations, 5 likely as a result of their hospital ex-perience. 5,6 Exposure to life-sustaining treatments during hospitalization provides patients with the experience necessary to help contextualize their advance care planning (ACP) choices and may provide a timely opportunity to educate patients about ACP before discharge. 7 Research supports the promise of multimedia decision aids for ACP.…”

“…7 Research supports the promise of multimedia decision aids for ACP. 6,8,9,10 In this study at two academic medical centers we explored the feasibility of a brief educational video tool combined with a hospital-based health educator in initiating ACP dialogue aimed at improving completion rates of advance directive (AD) and physician orders for life sustaining treatment (POLST) forms.…”