Capsule Commentary on Volandes et al., Use of Video Decision Aids to Promote Advance Care Planning in Hilo, Hawai’i
Capsule Commentary on Volandes et al., Use of Video Decision Aids to Promote Advance Care Planning in Hilo, Hawai'i
Jeffrey L. Jackson 0 1
0 Compliance with Ethical Standards:
1 Medical College of Wisconsin and Zablocki VAMC , Milwaukee, WI , USA
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A to assure that care provision is concordant with the
dvanced care planning is a shared medical decision tool
patient’s wishes.1 In this study, Volandes and colleagues
collaborated with the Hawaii Service Association to implement
video decision aids for care planning2 across all islands in the
state. In addition, the state included this as a pay-for-quality
measure for the state, and providers were eligible for financial
incentives for documenting advanced care planning. Not
surprisingly, the rate of care planning went up significantly, from
3.2% to 39.9%. Given that the study cohort was patients aged
75 years or older, the surprise isn’t the improvement in care
planning, but that this intervention still left over two-thirds of
the elderly with no advanced care planning. The authors
correctly point out that a study limitation was the lack of
tracking to see which providers offered the videos and which
patients actually viewed them. While the study had an
impressive increase in patients choosing hospice, it is impossible to
definitively assess the video’s impact on specific patient
behavior.
Modern technology allows providers to include an array
of platforms to communicate with their patients. Previous
studies suggest they might be helpful with minority
populations.3,4 This intervention was a video decision tool,
but one could easily see motivated health systems hosting
these videos on their webpages, on their Facebook
accounts and even pushing them to patients. As the current,
computer savvy generation ages, one can imagine
innumerable opportunities for asynchronous communication
and education. This study is a good first step towards
assessing the potential impact of video decision aids.
Future research needs to provide more granular,
patientcentered data, which is lacking from this intervention.
Given that this is a patient-centered decision aid, it is
ironic that the patient's voice is missing from this study.
We don’t know who watched the video or their reaction to
it. Hawaii has a very distinct culture; creating videos that
are culturally sensitive and specific will be a challenge for
providers wishing to use them with their patients. It would
have been very interesting and potentially enlightening to
have assessed a kamaàina (native Hawaiian) reaction to a
video created by Boston Haole (Hawaii newcomer).
Conflicts of Interest: The author has no conflicts of interest with this
article.
1. Institute of Medicine. Dying in America, improving quality and honoring individual preferences near the end of life . Washington DC: The National Academies Press; 2014 .
2. Volandes AE , Paasche-Orlow MK , Davis AD , Eubanks R , El-Jawahri A , Seitz R . Use of video decision aids to promote advance care planning in Hilo, Hawai'i . J Gen Intern Med . 2016 . doi: 10 .1007/s11606-016-3730-2.
3. Nathan AG , Marshall IM , Cooper JM , Huang ES . Use of decision aids with minority patients: a systematic review . J Gen Intern Med . 2016 ; 31 ( 6 ): 663 - 76 . doi: 10 .1007/s11606-016-3609-2.
4. Sajid S , Kotwal AA , Dale W. Interventions to improve decision making and reduce racial and ethnic disparities in the management of prostate cancer: a systematic review . J Gen Intern Med . 2012 ; 27 ( 8 ): 1068 - 78 . doi: 10 .1007/ s11606-012-2086-5. (...truncated)