Use of Video Decision Aids Increases Advance Care Planning
A program encouraging physicians and other providers to discuss with patients their preferences regarding end-of-life care significantly increased the documented incidence of such conversations and the number of patients with late-stage disease who were discharged to hospice. In a Journal of General Internal Medicine paper that has been released online, a team led by Massachusetts General Hospital (MGH) investigators describes the pilot program, which is part of a larger initiative to transform medical care for serious illness in the state of Hawaii. The program included video decision aids in 10 languages and was carried out in the city of Hilo, Hawaii. Beginning in early 2013, Hilo Medical Center clinicians, Hospice of Hilo staff and 30 primary care physicians in the city were offered a one- to four-hour training program and access to advance care planning video decision aids. Less than 10 minutes long, the videos are designed to be accessible to general audiences and include broad questions that patients should consider regarding their individual preferences and how they could affect future medical interventions. How or whether providers used the videos in subsequent advance care planning discussions was neither required nor tracked. Prior to implementation of the training program, the rate of advance care planning documentation for late-stage patients at Hilo Medical Center was 3.2 percent, but during the 21 months after training was offered, the rate increased to almost 40 percent. Among almost 4,000 HMSA patients over age 75 in Hilo who saw a primary care physician during 2014, the year following primary care physician training, 37 percent received advance care planning, compared with 25.6 percent in the control communities.
David Wingate is an elder law attorney at the Elder Law Office of David Wingate, LLC. The elder law office services clients with powers of attorneys, living wills, Wills, Trusts, Medicaid and asset protection. The Elder Law office has locations in Frederick and Montgomery Counties, Maryland.