A randomized controlled trial of a cardiopulmonary resuscitation (CPR) video decision support tool for seriously ill hospitalized patients with advanced cancer.

2015 ◽  
Vol 33 (29_suppl) ◽  
pp. 7-7
Author(s):  
Areej El-Jawahri ◽  
Jennifer S. Temel ◽  
Kavitha Ramchandran ◽  
Vicki A. Jackson ◽  
Yuchiao Chang ◽  
...  
Keyword(s):  
Decision Support ◽  
Advanced Cancer ◽  
Controlled Trial ◽  
Decision Support Tool ◽  
Hospitalized Patients ◽  
Support Tool ◽  
Randomized Controlled ◽  
End Of Life Decision ◽  
Seriously Ill ◽  
Life Decision

7 Background: Discussing CPR preferences with patients with advanced cancer who are hospitalized is a critical component of end-of-life decision making. However, these discussions are challenging and often avoided by clinicians. We examined the impact of a CPR video decision tool on patients’ choices and knowledge about CPR, and their comfort with watching the video. Methods: We conducted a multi-center randomized controlled trial of 116 patients with advanced cancer hospitalized at two academic oncology centers. We randomized patients to either a 3-minute video describing CPR (n = 52) or standard-oncology care (n = 64). The primary outcome was participants’ preferences for CPR (immediately after viewing the video in the intervention arm). Secondary outcomes included patients’ knowledge (using 5-item questionnaire with higher score reflects greater knowledge), and intervention participants’ comfort with watching the video. Results: The mean age was 66 years (SD = 12); 50% were women, 84% were white, and 48% had lung or gastrointestinal cancer. Only 47% of study participants reported having a discussion about their CPR preferences at the time of admission to the hospital. At baseline, there were no differences in patients’ preferences for not wanting CPR between the intervention and control arms (63% vs. 58%, P = 0.79). After the intervention, participants randomized to the video were more likely not to want CPR (81% vs. 58%, P = 0.03) and were more knowledgeable (mean knowledge score 4.3 vs. 3.2, P < 0.0001) versus control participants. In the intervention arm, 81% of participants found the video helpful, and 94% felt comfortable watching it and would recommend it to others. Conclusions: Seriously ill hospitalized patients with advanced cancer who watched a CPR video decision support tool were more likely not to want CPR and were better informed about their options. Participants reported feeling comfortable watching the video and would recommend it to others facing similar decisions. Video decision support tools can facilitate end-of-life decision-making for hospitalized patients with advanced cancer. Clinical trial information: NCT01527331.

scholarly journals A Randomized Controlled Trial of a CPR and Intubation Video Decision Support Tool for Hospitalized Patients

2015 ◽  
Vol 30 (8) ◽  
pp. 1071-1080 ◽  
Author(s):  
Areej El-Jawahri ◽  
Susan L. Mitchell ◽  
Michael K. Paasche-Orlow ◽  
Jennifer S. Temel ◽  
Vicki A. Jackson ◽  
...  
Keyword(s):  
Randomized Controlled Trial ◽  
Decision Support ◽  
Controlled Trial ◽  
Decision Support Tool ◽  
Hospitalized Patients ◽  
Support Tool ◽  
Randomized Controlled

scholarly journals Randomized Controlled Trial of a Video Decision Support Tool for Cardiopulmonary Resuscitation Decision Making in Advanced Cancer

2013 ◽  
Vol 31 (3) ◽  
pp. 380-386 ◽  
Author(s):  
Angelo E. Volandes ◽  
Michael K. Paasche-Orlow ◽  
Susan L. Mitchell ◽  
Areej El-Jawahri ◽  
Aretha Delight Davis ◽  
...  
Keyword(s):  
Decision Making ◽  
Randomized Controlled Trial ◽  
Decision Support ◽  
Cardiopulmonary Resuscitation ◽  
Advanced Cancer ◽  
Controlled Trial ◽  
Decision Support Tool ◽  
Successful Resuscitation ◽  
Support Tool ◽  
Randomized Controlled

Purpose Decision making regarding cardiopulmonary resuscitation (CPR) is challenging. This study examined the effect of a video decision support tool on CPR preferences among patients with advanced cancer. Patients and Methods We performed a randomized controlled trial of 150 patients with advanced cancer from four oncology centers. Participants in the control arm (n = 80) listened to a verbal narrative describing CPR and the likelihood of successful resuscitation. Participants in the intervention arm (n = 70) listened to the identical narrative and viewed a 3-minute video depicting a patient on a ventilator and CPR being performed on a simulated patient. The primary outcome was participants' preference for or against CPR measured immediately after exposure to either modality. Secondary outcomes were participants' knowledge of CPR (score range of 0 to 4, with higher score indicating more knowledge) and comfort with video. Results The mean age of participants was 62 years (standard deviation, 11 years); 49% were women, 44% were African American or Latino, and 47% had lung or colon cancer. After the verbal narrative, in the control arm, 38 participants (48%) wanted CPR, 41 (51%) wanted no CPR, and one (1%) was uncertain. In contrast, in the intervention arm, 14 participants (20%) wanted CPR, 55 (79%) wanted no CPR, and 1 (1%) was uncertain (unadjusted odds ratio, 3.5; 95% CI, 1.7 to 7.2; P < .001). Mean knowledge scores were higher in the intervention arm than in the control arm (3.3 ± 1.0 v 2.6 ± 1.3, respectively; P < .001), and 65 participants (93%) in the intervention arm were comfortable watching the video. Conclusion Participants with advanced cancer who viewed a video of CPR were less likely to opt for CPR than those who listened to a verbal narrative.

scholarly journals Reduction of the long-term use of proton pump inhibitors by a patient-oriented electronic decision support tool (arriba-PPI): study protocol for a randomized controlled trial

Trials ◽  
2019 ◽  
Vol 20 (1) ◽  
Author(s):  
Anja Rieckert ◽  
Annette Becker ◽  
Norbert Donner-Banzhof ◽  
Annika Viniol ◽  
Bettina Bücker ◽  
...  
Keyword(s):  
Randomized Controlled Trial ◽  
Decision Support ◽  
Controlled Trial ◽  
Decision Support Tool ◽  
Routine Care ◽  
Electronic Decision Support ◽  
Support Tool ◽  
Randomized Controlled ◽  
Cluster Randomized

Abstract Background Proton pump inhibitors (PPIs) are increasingly being prescribed, although long-term use is associated with multiple side effects. Therefore, an electronic decision support tool with the aim of reducing the long-term use of PPIs in a shared decision-making process between general practitioners (GPs) and their patients has been developed. The developed tool is a module that can be added to the so-called arriba decision support tool, which is already used by GPs in Germany in routine care. In this large-scale cluster-randomized controlled trial we evaluate the effectiveness of this arriba-PPI tool. Methods The arriba-PPI tool is an electronic decision support system that supports shared decision-making and evidence-based decisions around the long-term use of PPIs at the point of care. The tool will be evaluated in a cluster-randomized controlled trial involving 210 GP practices and 3150 patients in Germany. GP practices will be asked to recruit 20 patients aged ≥ 18 years regularly taking PPIs for ≥ 6 months. After completion of patient recruitment, each GP practice with enrolled patients will be cluster-randomized. Intervention GP practices will get access to the software arriba-PPI, whereas control GPs will treat their patients as usual. After an observation period of six months, GP practices will be compared regarding the reduction of cumulated defined daily doses of PPI prescriptions per patient. Discussion Our principal hypothesis is that the application of the arriba-PPI tool can reduce PPI prescribing in primary care by at least 15% compared to conventional strategies used by GPs. A positive result implies the implementation of the arriba-PPI tool in routine care. Trial registration German Clinical Trials Register, DRKS00016364. Registered on 31 January 2019.

A video decision support tool for CPR in advanced cancer: A randomized controlled trial.

2012 ◽  
Vol 30 (15_suppl) ◽  
pp. 9004-9004
Author(s):  
Angelo E. Volandes ◽  
Michael Paasche-Orlow ◽  
Areej El-Jawahri ◽  
Susan L. Mitchell ◽  
Margaret Kemeny ◽  
...  
Keyword(s):  
Randomized Controlled Trial ◽  
Decision Support ◽  
Advanced Cancer ◽  
Controlled Trial ◽  
Knowledge Score ◽  
The United States ◽  
Verbal Description ◽  
Support Tool ◽  
Randomized Controlled ◽  
Video Group

9004 Background: End-of-life decision-making is important to patients, including whether or not to attempt cardiopulmonary resuscitation (CPR). Doctors often rely solely on verbal descriptions to communicate information regarding CPR. Video decision support tools have the potential to improve patients’ understanding of CPR by providing visual images of what this intervention entails. The objective of this study was to examine the effect of a CPR video among patients with advanced cancer on their preferences and knowledge of CPR. Methods: A randomized controlled trial of 150 subjects with diverse advanced cancers (< 1-year prognosis) recruited from 4 cancer centers in the United States. Subjects were randomized to either a verbal narrative describing CPR, or to a video with verbal narrative. The video depicts CPR and reviews the success rate in advanced cancer. Study endpoints were subjects’ CPR preferences, knowledge of CPR (knowledge scores ranged from 0-4, higher score indicating more knowledge), and perceived value of the video. Chi-square tests were used to compare the distributions of categorical outcomes and two-sample t-tests were used to compare the means between the two groups. Results: A total of 150 subjects were randomized to a verbal narrative (n=80) or video with verbal narrative (n=70). Mean age was 62, 49% were women, 47% White, 34% Black, and 47% had lung or colon cancer. Among subjects receiving the verbal narrative, 38 (47.5%) preferred to have CPR attempted; 41 (51.2%) chose not to have CPR; and 1 (1.3%) was uncertain. In the video group, 14 (20%) preferred to have CPR attempted; 55 (78.6%) chose not to have CPR; and 1 (1.4%) was uncertain (P<0.001). The mean knowledge score was higher in the video group than in the verbal group (3.3 vs. 2.6 respectively; P<0.001). Of the subjects who viewed the video, 94.1% stated they were comfortable watching the video, 97.1% found the video helpful, and 100% would recommend the video. Conclusions: Compared to subjects who only heard a verbal description, subjects with advanced cancer who viewed a CPR video were more likely to prefer not having CPR, and were more knowledgeable about CPR. The majority of subjects found the video helpful, comfortable to view, and would recommend it to others.

Sign in / Sign up

Export Citation Format

Share Document