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

What You Need to Know Before You Apply

What is the purpose of this trial?

This trial tests a video conversation aid to improve communication about end-of-life care for older adults who have been injured. The goal is to determine if this video can make these difficult discussions easier and more aligned with patients' true wishes. Participants are divided into two groups: one using the video aid and the other receiving usual care. Eligible participants include those admitted to the hospital after an injury who can speak English or Spanish. As an unphased trial, this study provides a unique opportunity to contribute to research that could enhance patient-centered communication in critical care settings.

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 prior data suggests that this video conversation aid is safe for end-of-life care discussions?

Research shows that video conversation aids are generally well-received by both patients and doctors. No specific safety concerns have been reported for these tools. Studies suggest they ease difficult end-of-life conversations. These videos enhance communication and ensure that a patient's wishes are understood and respected. No negative effects or safety issues have been found, making them a safe choice for improving patient care discussions. ^{1 2 3 4 5}

Why are researchers excited about this trial?

Researchers are excited about the video conversation aid because it offers a fresh approach to end-of-life care discussions. Unlike traditional methods, which often rely solely on verbal communication, this tool incorporates visual elements to help patients and families better understand their options. By facilitating clearer, more engaging conversations, it aims to improve decision-making and ensure that end-of-life care aligns with the patient’s wishes. This innovative method has the potential to enhance the quality of these critical discussions, leading to more personalized and satisfactory care experiences.

What evidence suggests that this video conversation aid is effective for end-of-life care discussions?

Research has shown that video conversation aids, which participants in this trial may receive, can enhance discussions about end-of-life care. These video tools simplify understanding of options, leading to better-informed care decisions. One study found that video planning reduced hospital visits in the last 90 days of life for nursing home residents with serious illnesses. Another study demonstrated that these aids can encourage individuals to document their care wishes and increase awareness of palliative care. Overall, these tools help people express their preferences and make choices that align with their values. ^{6 7 8 9 10}

Who Is on the Research Team?

Thaddeus J Puzio, MD, MS, FACS

Principal Investigator

The University of Texas Health Science Center, Houston

Are You a Good Fit for This Trial?

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 for a Trial Participant

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

What Are the Treatments Tested in This Trial?

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.

How Is the Trial Designed?

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+

Published Research Related to This Trial

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]

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]

Citations

1. pmc.ncbi.nlm.nih.gov pmc.ncbi.nlm.nih.gov/articles/PMC8885779/

Effect of a Video-assisted Advance Care Planning ... Video-assisted ACP was modestly associated with reduced hospital transfers in the last 90 days of life among nursing home residents with advanced illness.

2. bmjopen.bmj.com bmjopen.bmj.com/content/5/6/e007491

Video decision aids to assist with advance care planning The objective of this study was to evaluate the impact of video decision aids on patients' preferences regarding life-sustaining treatments (primary outcome).

3. sciencedirect.com sciencedirect.com/science/article/pii/S0885392419310589

Randomized Controlled Trial of Advance Care Planning ... This study shows that ACP video decision aid could enhance the intention to document ACP and awareness of palliative care in the general population.

4. bmcpalliatcare.biomedcentral.com bmcpalliatcare.biomedcentral.com/articles/10.1186/s12904-021-00794-3

Video decision support tool promoting values conversations in ... This study will evaluate the potential utility of a video decision support tool (VDST) that models values-based ACP discussions between cancer patients and ...

5. jamanetwork.com jamanetwork.com/journals/jamanetworkopen/fullarticle/2789397

Association of an Advance Care Planning Video and ... This nonrandomized controlled trial assesses whether an advance care planning intervention improved rates of advance care planning in older ...

6. pmc.ncbi.nlm.nih.gov pmc.ncbi.nlm.nih.gov/articles/PMC10495866/

Video Intervention Goals-of-Care Older Adults: VIDEO-PCE Trial Goals-of-care documentation is the composite of conversations about goals, limitation of life-sustaining treatment, palliative care, hospice, ...

7. acpdecisions.org acpdecisions.org/10-ways-video-decision-aids-support-the-care-of-seriously-ill-populations/

10 Ways Video Decision Aids Support the Care of Seriously Ill ... Ease the transition from the treatment stage of a serious illness to end-of-life care by facilitating difficult end-of-life conversations. The ...

8. publichealth.jhu.edu publichealth.jhu.edu/center-for-health-services-outcomes-research/information-calendar/videos

Videos | Center for Health Services and Outcomes Research This presentation discusses key issues in patient safety at the end of life, particularly the key area of improving documentation of patient preferences for ...

9. healthopenresearch.org healthopenresearch.org/articles/3-5

Evaluating the use of video communication... The aim of this evaluation was to describe the experience of a UK based hospital specialist palliative care team, who were using video communication technology ...

10. withpower.com withpower.com/trial/video-conversation-aid-for-end-of-life-care-discussions-c13da

Video Conversation Aid for End-of-Life Care Discussions 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, ...