Departments of Medicine, Neurology and Cancer Center, and Oncology, Massachusetts General Hospital, 50 Staniford St, 9th floor, Boston, MA 02114, USA.
J Clin Oncol. 2010 Jan 10;28(2):305-10. doi: 10.1200/JCO.2009.24.7502. Epub 2009 Nov 30.
To determine whether the use of a goals-of-care video to supplement a verbal description can improve end-of-life decision making for patients with cancer.
Fifty participants with malignant glioma were randomly assigned to either a verbal narrative of goals-of-care options at the end of life (control), or a video after the same verbal narrative (intervention) in this randomized controlled trial. The video depicts three levels of medical care: life-prolonging care (cardiopulmonary resuscitation [CPR], ventilation), basic care (hospitalization, no CPR), and comfort care (symptom relief). The primary study outcome was participants' preferences for end-of-life care. The secondary outcome was participants' uncertainty regarding decision making (score range, 3 to 15; higher score indicating less uncertainty). Participants' comfort level with the video was also measured.
Fifty participants were randomly assigned to either the verbal narrative (n = 27) or video (n = 23). After the verbal description, 25.9% of participants preferred life-prolonging care, 51.9% basic care, and 22.2% comfort care. In the video arm, no participants preferred life-prolonging care, 4.4% preferred basic care, 91.3% preferred comfort care, and 4.4% were uncertain (P < .0001). The mean uncertainty score was higher in the video group than in the verbal group (13.7 v 11.5, respectively; P < .002). In the intervention arm, 82.6% of participants reported being very comfortable watching the video.
Compared with participants who only heard a verbal description, participants who viewed a goals-of-care video were more likely to prefer comfort care and avoid CPR, and were more certain of their end-of-life decision making. Participants reported feeling comfortable watching the video.
确定在生命末期使用目标关怀视频来补充口头描述是否可以改善癌症患者的临终决策。
在这项随机对照试验中，50 名患有恶性胶质瘤的参与者被随机分配到生命末期的口头叙述目标关怀选择（对照组）或口头叙述后的视频（干预组）。该视频描绘了三种医疗护理水平：延长生命的护理（心肺复苏术 [CPR]、通气）、基本护理（住院、无 CPR）和舒适护理（缓解症状）。主要研究结果是参与者对临终关怀的偏好。次要结果是参与者对决策的不确定性（评分范围为 3 到 15；得分越高表示不确定性越低）。还测量了参与者对视频的舒适程度。
50 名参与者被随机分配到口头叙述组（n = 27）或视频组（n = 23）。在口头描述后，25.9%的参与者更喜欢延长生命的护理，51.9%的参与者更喜欢基本护理，22.2%的参与者更喜欢舒适护理。在视频组中，没有参与者喜欢延长生命的护理，4.4%的参与者喜欢基本护理，91.3%的参与者喜欢舒适护理，4.4%的参与者不确定（P<0.0001）。视频组的平均不确定性评分高于口头组（分别为 13.7 和 11.5，P<0.002）。在干预组中，82.6%的参与者报告观看视频非常舒适。
与仅听取口头描述的参与者相比，观看目标关怀视频的参与者更有可能选择舒适护理并避免心肺复苏术，并且对其临终决策更有把握。参与者报告观看视频感到舒适。
