Feasibility and Patient Perceptions of Video Declarations Regarding End-of-Life Decisions by Hospitalized Patients

Background: A videotaped declaration by patients of their advance care planning preferences could be an opportunity to supplement advance directive forms and be a source of information for family, caregivers, and clinicians, yet research is needed to examine the content and acceptability of making declarations among patients.

Objective: To evaluate the content and acceptability of ‘video declarations’: the process of patients videotaping themselves describing their advance care planning preferences.

Design: We showed a brief video describing three approaches to end-of-life care and then invited participants to use an iPad to videotape themselves making a declaration about their wishes.

Setting/Subjects: Hospitalized patients from a large urban U.S. safety net hospital.

Measurements: We interviewed participants about the acceptability of the declaration process. Declarations were transcribed and coded by a team, with multiple stakeholder input.

Results: There were 16 participants; mean age was 60 (SD = 14) years. One participant declined. Out of 15 declarations, most were able to express their wishes for CPR (n = 12) and intubation (n = 13). Participants frequently discussed their family structure (n = 11), religious/spiritual well-being (n = 8), legacy/dignity issues (n = 6), and physical symptoms (n = 6). Nine declarations had directives judged to be unclear. The majority (66%) thought that this process was quite a bit or extremely helpful.

Conclusions: Findings show that asking hospitalized patients to make videos describing their advance care planning preferences was feasible and acceptable. While the majority described their wishes around CPR and intubation, a fair amount of uncertainty remained. Further research is needed to support patients in describing their wishes clearly and test the effectiveness of video declarations to promote care concordant with preferences.