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- Title
Video Intervention and Goals-of-Care Documentation in Hospitalized Older Adults: The VIDEO-PCE Randomized Clinical Trial.
- Authors
Volandes, Angelo E.; Zupanc, Sophia N.; Lakin, Joshua R.; Cabral, Howard J.; Burns, Edith A.; Carney, Maria T.; Lopez, Santiago; Itty, Jennifer; Emmert, Kaitlin; Martin, Narda J.; Cole, Therese; Dobie, Alexandra; Cucinotta, Traci; Joel, Milton; Caruso, Lisa B.; Henault, Lori; Dugas, Julianne N.; Astone, Kristina; Winter, Michael; Wang, Na
- Abstract
This stepped-wedge cluster randomized clinical trial assesses whether implementation of an evidence-based goals-of-care (GOC) video intervention delivered by palliative care educators to older adults in a hospital setting improves GOC documentation. Key Points: Question: Can implementing an evidence-based goals-of-care (GOC) video intervention delivered by palliative care educators (PCEs) in hospital settings improve GOC documentation among older patients? Findings: In this pragmatic, stepped-wedge cluster randomized clinical trial that included 10 802 adults aged 65 years or older from 14 units at 2 US hospitals, patients randomized to hospital units receiving the GOC video intervention had more GOC documentation than patients randomized to hospital units receiving usual care. Meaning: In this trial, the use of a GOC video intervention delivered by PCEs improved GOC documentation for older adults in hospital settings. Importance: Despite the benefits of goals-of-care (GOC) communication, many hospitalized individuals never communicate their goals or preferences to clinicians. Objective: To assess whether a GOC video intervention delivered by palliative care educators (PCEs) increased the rate of GOC documentation. Design, Setting, and Participants: This pragmatic, stepped-wedge cluster randomized clinical trial included patients aged 65 years or older admitted to 1 of 14 units at 2 urban hospitals in New York and Boston from July 1, 2021, to October 31, 2022. Intervention: The intervention involved PCEs (social workers and nurses trained in GOC communication) facilitating GOC conversations with patients and/or their decision-makers using a library of brief, certified video decision aids available in 29 languages. Patients in the control period received usual care. Main Outcome and Measures: The primary outcome was GOC documentation, which included any documentation of a goals conversation, limitation of life-sustaining treatment, palliative care, hospice, or time-limited trials and was obtained by natural language processing. Results: A total of 10 802 patients (mean [SD] age, 78 [8] years; 51.6% male) were admitted to 1 of 14 hospital units. Goals-of-care documentation during the intervention phase occurred among 3744 of 6023 patients (62.2%) compared with 2396 of 4779 patients (50.1%) in the usual care phase (P <.001). Proportions of documented GOC discussions for Black or African American individuals (865 of 1376 [62.9%] vs 596 of 1125 [53.0%]), Hispanic or Latino individuals (311 of 548 [56.8%] vs 218 of 451 [48.3%]), non-English speakers (586 of 1059 [55.3%] vs 405 of 863 [46.9%]), and people living with Alzheimer disease and related dementias (520 of 681 [76.4%] vs 355 of 570 [62.3%]) were greater during the intervention phase compared with the usual care phase. Conclusions and Relevance: In this stepped-wedge cluster randomized clinical trial of older adults, a GOC video intervention delivered by PCEs resulted in higher rates of GOC documentation compared with usual care, including among Black or African American individuals, Hispanic or Latino individuals, non-English speakers, and people living with Alzheimer disease and related dementias. The findings suggest that this form of patient-centered care delivery may be a beneficial decision support tool. Trial Registration: ClinicalTrials.gov Identifier: NCT04857060
- Subjects
NEW York (State); MASSACHUSETTS; HOSPICE care; RESEARCH; SOCIAL workers; PALLIATIVE care nurses; NATURAL language processing; PHYSICIAN-patient relations; AUDIOVISUAL materials; PATIENTS' attitudes; DOCUMENTATION; TREATMENT effectiveness; RANDOMIZED controlled trials; URBAN hospitals; DECISION making; HOSPITAL care of older people; DESCRIPTIVE statistics; RESEARCH funding; COMMUNICATION; PALLIATIVE treatment
- Publication
JAMA Network Open, 2023, Vol 6, Issue 9, pe2332556
- ISSN
2574-3805
- Publication type
Article
- DOI
10.1001/jamanetworkopen.2023.32556