Educational video helps terminal cancer patients make a decision about receiving CPR
Patients with terminal cancer who watched a 3-minute video demonstrating cardiopulmonary resuscitation (CPR) were less likely to indicate a preference for receiving CPR in the event of an in-hospital cardiac arrest than were patients who only listened to a verbal description of the procedure.
This study was a follow-up to a smaller, 2009 study and includes a more diverse group of patients with many forms of cancer. The earlier study enrolled only patients with brain cancer, which represents less than 1% of cancer diagnoses. Among the enrollees in the current study, one third were African American and 10% were Hispanic. The current study focused on the choice to receive CPR, which is a decision that can have a major impact on the course of a patient's care.
At each of four cancer centers, cancer patients who were aware that their prognosis was less than 1 year were invited to participate in the study immediately after a scheduled clinic visit. The 150 patients who agreed to participate first completed a questionnaire that included details of their personal background and their current preferences regarding CPR. Then, the patients were randomized into two groups, and all the patients listened to identical verbal narratives describing the goals, processes, and risks of CPR, including the likelihood of successful resuscitation in patients with advanced cancer.
One group of 70 patients then watched the video, which included images of a simulated CPR procedure conducted on a mannequin and of a real patient on mechanical ventilation receiving intravenous medication. (The video can be viewed at www.acpdecisions.org/#&panel1-4.) Both groups then completed a second questionnaire that once again ascertained their knowledge about CPR and asked the same questions regarding CPR preferences. After 6 to 8 weeks, a member of the research team, who did not know to which group patients had been assigned, attempted to contact them by phone to administer a follow-up questionnaire.
Before beginning the study, about half of those in both groups indicated they would choose to receive CPR. That preference dropped slightly, from 54% to 48%, among the 80 control patients who only listened to the verbal description of CPR. Among those who watched the video, the preference for CPR dropped by more than half from 49% to 20%.
Successful follow-up calls were made to 67 patients, including 30 who had viewed the video. The video was described as helpful by 90% of those who saw it, 93% said they were comfortable viewing it, and 98% would probably or definitely recommend it to other patients with advanced cancer.
“It really is incumbent on us, as physicians, to help our patients understand their options at the end of life,” says Angelo Volandes, MD, MPH, of the Massachusetts General Hospital. “Our results clearly show that educational videos can help supplement—not supplant—the patient/doctor relationship by reinforcing, not replacing, the conversations that must take place between doctors and patients.”
This study was published in Journal of Clinical Oncology (2012; doi:10.1200/JCO.2012.43.9570).