Can a patient-directed video improve inpatient advance care planning? A prospective pre-post cohort study

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.