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Original research
Can a patient-directed video improve inpatient advance care planning? A prospective pre-post cohort study
  1. Rajesh Nair1,
  2. Samuel Abuaf Kohen2
  1. 1 Institute on Aging & Lifelong Health, University of Victoria, Victoria, British Columbia, Canada
  2. 2 Intensive Care Unit, Comox Valley Hospital, Courtenay, British Columbia, Canada
  1. Correspondence to Dr Samuel Abuaf Kohen, Intensive Care Unit, Comox Valley Hospital, Courtenay, BC V9N 0B9, Canada; samuel.kohen{at}viha.ca

Abstract

Background Patients and their families often have an inadequate understanding of the risks and benefits of their advance care planning (ACP) options. Improving patients’ knowledge of therapeutic interventions allows them to better select treatments they believe are most appropriate for their condition.

Objectives To determine if a video aimed at educating and engaging hospitalised patients on a standardised ACP order set can improve (1) inpatient understanding of key ACP concepts, (2) ACP documentation within 48 hours of hospital admission, (3) concordance between a patient’s expressed and chart-documented care preferences, (4) patient satisfaction with decision-making, and (5) patient’s decisional confidence.

Methods A prospective, non-randomised, pre-post intervention study of 252 inpatients in a 215-bed community-based hospital in Comox, British Columbia, Canada.

Results Our video decision support tool was associated with significant improvements in (1) patient understanding of key ACP concepts (70%–100%; p<0.0001), (2) ACP documentation within 48 hours of hospital admission (81%–92%; p=0.01), (3) concordance between patients’ expressed wishes and chart documentation (69%–89%; p<0.0001), (4) patient satisfaction with decision-making (Canadian Health Care Evaluation Project Lite score: 4.3–4.5, p=0.001), and (5) patient’s decisional confidence (patients with no decisional conflict, increased from 72% to 93%; p<0.0001).

Conclusion A 13 min video aimed at educating and engaging inpatients on ACP concepts improved patient understanding of key ACP concepts, rates of ACP documentation and patient satisfaction with decision-making.

  • communication
  • decision-making
  • patient education
  • patient-centred care
  • patient satisfaction

This is an open access article distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited, appropriate credit is given, any changes made indicated, and the use is non-commercial. See: http://creativecommons.org/licenses/by-nc/4.0/.

http://dx.doi.org/10.1136/bmjqs-2018-009066

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    Footnotes

    • Contributors RN and SAK led the study. SAK acquired funding, designed the study and aided in implementation. RN assisted in study design, oversaw implementation and managed the project's daily operations. RN and SAK wrote and revised the manuscript.

    • Funding The study was funded by BC Special Services Committee, Comox Valley Division of Family Practice, Comox Valley Healthcare Foundation and St Joseph's General Hospital Auxiliary.

    • Competing interests None declared.

    • Patient consent for publication Obtained.

    • Ethics approval The SJGH administration and ethics committee approved the study.

    • Provenance and peer review Not commissioned; externally peer reviewed.

    • Data sharing statement All data relevant to the study are included in the article or uploaded as supplementary information.