Harvard Medical School, Boston, MA 02114, USA.
J Palliat Med. 2012 Jul;15(7):805-11. doi: 10.1089/jpm.2011.0505. Epub 2012 May 4.
To determine the impact of a video on preferences for the primary goal of care.
DESIGN, SUBJECTS, AND INTERVENTION: Consecutive subjects 65 years of age or older (n=101) admitted to two skilled nursing facilities (SNFs) were randomized to a verbal narrative (control) or a video (intervention) describing goals-of-care options. Options included: life-prolonging (i.e., cardiopulmonary resuscitation), limited (i.e., hospitalization but no cardiopulmonary resuscitation), or comfort care (i.e., symptom relief).
Primary outcome was patients' preferences for comfort versus other options. Concordance of preferences with documentation in the medical record was also examined.
Fifty-one subjects were randomized to the verbal arm and 50 to the video arm. In the verbal arm, preferences were: comfort, n=29 (57%); limited, n=4 (8%); life-prolonging, n=17 (33%); and uncertain, n=1 (2%). In the video arm, preferences were: comfort, n=40 (80%); limited, n=4 (8%); and life-prolonging, n=6 (12%). Randomization to the video was associated with greater likelihood of opting for comfort (unadjusted rate ratio, 1.4; 95% confidence interval [CI], 1.1-1.9, p=0.02). Among subjects in the verbal arm who chose comfort, 29% had a do-not-resuscitate (DNR) order (κ statistic 0.18; 95% CI-0.02 to 0.37); 33% of subjects in the video arm choosing comfort had a DNR order (κ statistic 0.06; 95% CI-0.09 to 0.22).
Subjects admitted to SNFs who viewed a video were more likely than those exposed to a verbal narrative to opt for comfort. Concordance between a preference for comfort and a DNR order was low. These findings suggest a need to improve ascertainment of patients' preferences.
Clinicaltrials.gov Identifier: NCT01233973.
确定视频对主要治疗目标选择的影响。
设计、研究对象和干预措施：连续纳入年龄在 65 岁或以上的（n=101）两位入住疗养院（SNFs）的患者，随机分为口头叙述（对照组）或视频（干预组）描述治疗目标的选择。选项包括：延长生命（即心肺复苏）、有限（即住院但不进行心肺复苏）或舒适护理（即缓解症状）。
主要结果是患者对舒适护理与其他选择的偏好。同时检查与医疗记录中记录的偏好的一致性。
51 名患者被随机分配到口头组，50 名被分配到视频组。在口头组中，偏好为：舒适护理，n=29（57%）；有限，n=4（8%）；延长生命，n=17（33%）；不确定，n=1（2%）。在视频组中，偏好为：舒适护理，n=40（80%）；有限，n=4（8%）；和延长生命，n=6（12%）。随机分配到视频组的患者更有可能选择舒适护理（未经调整的率比，1.4；95%置信区间[CI]，1.1-1.9，p=0.02）。在口头组中选择舒适护理的患者中，有 29%有不复苏（DNR）医嘱（κ 统计量 0.18；95%CI-0.02 至 0.37）；在选择舒适护理的视频组中，有 33%的患者有 DNR 医嘱（κ 统计量 0.06；95%CI-0.09 至 0.22）。
与接受口头叙述的患者相比，入住疗养院的患者观看视频后更有可能选择舒适护理。对舒适护理的偏好与 DNR 医嘱之间的一致性较低。这些发现表明需要改进对患者偏好的确定。
Clinicaltrials.gov 标识符：NCT01233973。
