Video Conversation Aids to Assist in Goals-Of-Care Discussions With Older Adults in a Medical Setting: A Systematic Review

Abstract

Background: Goals-of-care (GOC) discussions align medical treatment with older adults’ preferences, yet are hindered by communication barriers, provider discomfort, and misinformation. Video-based decision aids improve understanding and reduce decision conflict, though data on their use in older populations remain limited. This review aimed to determine the effectiveness of video-based decision aids in improving GOC discussions and decision-making outcomes among older adults. Methods: For this systematic review, a medical librarian conducted a literature search of Medline, Embase, Web of Science, CINAHL, PsychINFO, and Cochrane from database inception through April 2025. Eligible studies evaluated a video-based aid in US adults aged ≥65 years to facilitate GOC or code status decisions. The Cochrane Risk of Bias tool was used to assess quality of randomized, interventional studies. Results: Of 4438 identified studies, 7 underwent full review, and 5 met inclusion criteria. Among inpatient settings, 2 studies found video interventions significantly increased patient preference for comfort-based care, while another using a shorter video, found no effect. In outpatient settings, one study found increased preference for comfort-based care with video intervention, while another reported no preference differences. Two studies assessed knowledge; one inpatient study found no change, while an outpatient study reported greater end-of-life knowledge in the intervention group. Video variability and differences in measured outcomes limited comparisons and generalizability. Conclusions: Video-based decision aids show promise for improving knowledge and aligning treatment preferences. Further studies are needed to investigate the impact of video-based decision aids on GOC conversations in older adults in acute care settings.