End-of-Life Choice, Palliative Care and Counseling

Fewer Cancer Patients Want CPR After Video Demoby Sonja

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by Andrew M. Seaman
Reuters Health
December 12, 2012

Dying cancer patients are less likely to want aggressive end-of-life care if they watch a short video about cardiopulmonary resuscitation (CPR) than if they simply hear about it, according to a new study.

“These are huge differences. You will die very differently if you watch the video than if you don’t,” said Dr. Angelo Volandes, the study’s lead author from Boston’s Massachusetts General Hospital.

All 150 cancer patients in the randomized study were thought to have less than a year to live. Of the 80 who were simply told about CPR, 48% said they wanted it, compared to 20% of the 70 patients who also watched a video showing compressions on a dummy and insertion of the endotracheal tube.

“It’s one of the most important issues in American medicine today. People are getting medical interventions that, if they had more knowledge, they would simply not want,” said Dr. Volandes.

The new study builds off previous research with similar findings by the same group. The earlier research, however, was only conducted with brain cancer patients at one medical center.

For the new study, published Monday in the Journal of Clinical Oncology, the researchers included a wider variety of cancer patients at four medical centers in Massachusetts, New York and Tennessee.

All of the patients who agreed to participate in the study were read a standardized description of CPR. The description also said CPR does not revive most patients with advanced cancer, and the patient would likely be put in the ICU on a ventilator if it worked.

In the group that was only told about CPR, about 52% of the 80 patients said they wouldn’t want to be resuscitated, compared to 79% of the patients who also watched the three-minute video.

Nine out of every ten patients who watched the video also said it was “helpful.”

Dr. Volandes told Reuters Health that the video may reinforce the information patients usually get from their doctors. “People aren’t clinicians. They don’t have clinic experience to understand what this looks like,” he said.

Dr. Susan Gaeta, an assistant professor at The University of Texas MD Anderson Cancer Center in Houston, told Reuters Health she likes the idea of using the videos, but said they need to be part of a bigger conversation.

“What we’re trying to do is to have conversation with patients on what their goals and values are,” said Dr. Gaeta.

She added that the question should not be, “Do you want this?” It should be, “Is this medically appropriate based on your goals and values?”

Dr. Volandes said their collection of 25 videos on various topics, including CPR and intubation, are used by over 30 healthcare systems across the country.

Dr. Gaeta added that her hospital is developing their own videos that incorporate their focus of goals and values.