Pilot Randomized Controlled Trial of an Advance Care Planning Video Decision Tool for Patients with Advanced Liver Disease (RP301)

• Published in: Journal of pain and symptom management Vol. 63; no. 6; pp. 1067 - 1068
• Main Authors: Ufere, Nneka, Robinson, Blair, Donlan, John, Indriolo, Teresa, Scherrer, Abigail, Bloom, Judith, Mason, Nancy, Patel, Arpan, Lai, Jennifer, Chung, Raymond, Volandes, Angelo, El-Jawahri, Areej
• Format: Journal Article
• Language: English
• Published: Madison Elsevier Inc 01.06.2022; Elsevier Limited
• Subjects: Advance directives; Anesthesia; Cardiopulmonary resuscitation; Care plans; Clinical trials; CPR; Decision support systems; Efficacy; End of life decisions; Feasibility; Hospice care; Hospitalization; Intervention; Intubation; Life goals; Liver diseases; Mechanical ventilation; Narratives; Pain Medicine; Palliative care; Research subjects
• ISSN: 0885-3924
• DOI: 10.1016/j.jpainsymman.2022.04.017

1. Identify current barriers to the delivery of advance care planning to patients with chronic liver disease 2. Interpret the results of a randomized control trial of an advance care video decision support tool versus verbal narrative control and compare outcomes of patients randomized to the video intervention or control arms of the trial Transplant-ineligible patients with advanced liver disease rarely receive timely advance care planning (ACP). Tools are needed to educate these patients about medical interventions available at the end of life to promote ACP. To assess the feasibility, acceptability, and preliminary efficacy of an ACP video decision support tool for improving transplant-ineligible advanced liver disease patients’ knowledge about and preferences for end-of-life care. In this single-site pilot randomized controlled trial, intervention participants watched a 5-minute ACP video decision support tool depicting 3 levels of goals of care: life-prolonging care (cardiopulmonary resuscitation [CPR] and intubation), life-limiting care (hospitalization, no CPR or intubation), and comfort care. Control subjects received a verbal narrative of these 3 levels of goals of care. The primary outcome was feasibility (≥60% enrollment rate). Secondary outcomes included acceptability of the video, patients’ knowledge of end-of-life care options (6-item test; range 0-6), and postintervention goals-of-care and CPR and intubation preferences. We enrolled 85% (50/59) of eligible patients randomly assigned to the video (n = 26) or verbal (n = 24) arm. Preferences to receive CPR (69% vs. 70%; p = 0.99) and knowledge assessment scores (3.3 vs. 3.2; p = 0.45) were similar between both arms at baseline. In the video arm, 81% of patients reported being very comfortable watching the video. Patients in the video arm had higher mean knowledge scores (5.7 vs. 4.8; p < 0.001) and were less likely to prefer to receive CPR compared to patients in the verbal arm (35% vs. 63%; p = 0.09). An ACP video decision support tool to improve knowledge about and preferences for end-of-life care is both feasible and highly acceptable to transplant-ineligible patients with advanced liver disease with a high enrollment rate and promising preliminary efficacy. Future studies should examine the efficacy of the ACP video for increasing the quality of end-of-life care for patients with advanced liver disease.