Video Conversation Aid for End-of-Life Care Discussions

(ADVISE Trial)

Overseen By Erin Fox

Age: 65+

Sex: Any

Trial Phase: Academic

Sponsor: The University of Texas Health Science Center, Houston

Disqualifiers: Prisoners, DNR/DNI, Hospice, others

No Placebo Group All trial participants will receive the active study treatment (no placebo)

Compensation: Varies

Number of Visits: 1

Duration: 5 days

270 Participants Needed

Trial Summary

Will I have to stop taking my current medications?

The trial information does not specify whether you need to stop taking your current medications.

What data supports the effectiveness of the treatment Video conversation aid for end-of-life care discussions?

Research shows that using a video to supplement verbal discussions can improve decision-making about end-of-life care for patients with cancer, suggesting that videos can help people better understand and make decisions about their care. ^{1 2 3 4 5}

Is the video conversation aid for end-of-life care discussions safe for humans?

The research does not provide specific safety data for the video conversation aid, but it suggests that the tool is generally accepted by clinicians, patients, and caregivers for facilitating end-of-life discussions. ^{1 2 3 6 7}

How is the Video Conversation Aid treatment unique for end-of-life care discussions?

The Video Conversation Aid is unique because it uses video to enhance communication about end-of-life care preferences, providing a visual and personal way to express wishes, which can be more impactful than verbal discussions alone. This approach helps patients and families better understand and communicate their preferences, potentially leading to more informed decision-making. ^{1 2 3 8 9}

What is the purpose of this trial?

The purpose of this study is to evaluate the effectiveness and implementation considerations of a video aid to improve communication and patient-centered outcomes in older injured adults

Research Team

Thaddeus J Puzio, MD, MS, FACS

Principal Investigator

The University of Texas Health Science Center, Houston

Eligibility Criteria

This trial is for older adults who have been admitted to care after a trauma and can communicate in English or Spanish. It's not for those already on hospice, not expected to live more than 48 hours, with existing DNR/DNI orders, or prisoners.

Inclusion Criteria

Admitted to any level of care following trauma

Exclusion Criteria

Patients admitted while on hospice

Patients not expected to survive over 24-48 hours

Existing do not resuscitate (DNR)/do not intubate (DNI)

Timeline

Screening

Participants are screened for eligibility to participate in the trial

1-2 weeks

Treatment

Participants receive a video-based support tool to aid in end-of-life care discussions

5 days

1 visit (in-person)

Follow-up

Participants are monitored for changes in code status and discharge disposition

5 days

Treatment Details

Interventions

• Video conversation aid

Trial Overview The study is testing a video aid designed to help improve conversations about end-of-life care compared to usual care without the video tool. The goal is to see if this improves patient-centered outcomes.

Participant Groups

Group I: Video conversation aid Experimental Treatment 1 Intervention

Group II: Usual Care Active Control 1 Intervention

Who Is Running the Clinical Trial?

The University of Texas Health Science Center, Houston

Lead Sponsor

Trials

974

Recruited

361,000+

Findings from Research

The Communicating Health Alternatives Tool (CHAT) was developed to help clinicians initiate end-of-life conversations with older adults, aiming to improve shared decision-making and reduce overtreatment in the last year of life.

User testing showed that clinicians, patients, and caregivers found CHAT easy to use and acceptable, suggesting it could effectively facilitate advance care planning and lead to better alignment of treatment with patient preferences.

NCBI (Pubmed)

pubmed.ncbi.nlm.nih.gov

Development and preliminary usability testing of an electronic conversation guide incorporating patient values and prognostic information in preparation for older people's decision-making near the end of life. Cardona, M., Lewis, ET., Bannach-Brown, A., et al.[2023]

In a pilot study involving 763 patients aged 79 and older, a physician assistant-led discussion using an electronic tool successfully changed resuscitation preferences in 83.7% of cases, indicating its potential effectiveness in facilitating end-of-life care discussions.

The intervention required an average of 50 minutes to complete, suggesting that while it was effective, it may need to be revised for efficiency to reach more eligible patients in future studies.

NCBI (Pubmed)

pubmed.ncbi.nlm.nih.gov

Evaluation of a program using a physician assistant and an electronic patient-provider communication tool to facilitate discussions about goals of care in older adults in hospital: a pilot study. Monchis, M., Martin, C., DiDiodato, G.[2021]

References

1. United States pubmed.ncbi.nlm.nih.gov

End-of-Life Discussions with Older Adults. [2018]

2. United States pubmed.ncbi.nlm.nih.gov

Use of video to facilitate end-of-life discussions with patients with cancer: a randomized controlled trial. [2022]

3. New Zealand pubmed.ncbi.nlm.nih.gov

A video depicting resuscitation did not impact upon patients' decision-making. [2022]

4. England pubmed.ncbi.nlm.nih.gov

The quality of patient-doctor communication about end-of-life care: a study of patients with advanced AIDS and their primary care clinicians. [2019]

5. England pubmed.ncbi.nlm.nih.gov

Use of a values inventory as a discussion aid about end-of-life care: A pilot randomized controlled trial. [2017]

6. Netherlands pubmed.ncbi.nlm.nih.gov

Development and preliminary usability testing of an electronic conversation guide incorporating patient values and prognostic information in preparation for older people's decision-making near the end of life. [2023]

7. Canada pubmed.ncbi.nlm.nih.gov

Evaluation of a program using a physician assistant and an electronic patient-provider communication tool to facilitate discussions about goals of care in older adults in hospital: a pilot study. [2021]

8. United States pubmed.ncbi.nlm.nih.gov

Me & My Wishes: Lessons Learned From Prototyping Resident Centered Videos About Care Preferences. [2022]

9. Ireland pubmed.ncbi.nlm.nih.gov

A systematic review of evidence for end-of-life communication interventions: Who do they target, how are they structured and do they work? [2018]