TRIAD VIII: Nationwide Multicenter Evaluation to Determine Whether Patient VideoTestimonials Can Safely Help Ensure Appropriate Critical Versus End-of-life Care

Authors

F Mirarchi
T Cooney
A Venkat
D Wang
T Pope
Kate Aberger, New York Medical College
B Gordon
N Ahuja
J Carlson
M Milliron
K Hart
C Gilbertson
J Wilson
L Mueller
L Brown
B Gordon

DOI

10.1097/PTS.0000000000000357

Journal Title

Journal of Patient Safety

First Page

51

Last Page

61

Document Type

Article

Publication Date

June 2017

Department

Emergency Medicine

Keywords

communication, comprehension, emergency medicine, family practice, internal medicine, living wills, physicians, resuscitation orders, safety, surveys and questionnaires, video recording, randomized controlled trial, multicenter study

Disciplines

Medicine and Health Sciences

Abstract

OBJECTIVE: End-of-life interventions should be predicated on consensus understanding of patient wishes. Written documents are not always understood; adding a video testimonial/message (VM) might improve clarity. Goals of this study were to (1) determine baseline rates of consensus in assigning code status and resuscitation decisions in critically ill scenarios and (2) determine whether adding a VM increases consensus. METHODS: We randomly assigned 2 web-based survey links to 1366 faculty and resident physicians at institutions with graduate medical education programs in emergency medicine, family practice, and internal medicine. Each survey asked for code status interpretation of stand-alone Physician Orders for Life-Sustaining Treatment (POLST) and living will (LW) documents in 9 scenarios. Respondents assigned code status and resuscitation decisions to each scenario. For 1 of 2 surveys, a VM was included to help clarify patient wishes. RESULTS: Response rate was 54%, and most were male emergency physicians who lacked formal advanced planning document interpretation training. Consensus was not achievable for stand-alone POLST or LW documents (68%-78% noted "DNR"). Two of 9 scenarios attained consensus for code status (97%-98% responses) and treatment decisions (96%-99%). Adding a VM significantly changed code status responses by 9% to 62% (P

Comments

Please see the work itself for the complete list of authors.

Recommended Citation

Mirarchi, F., Cooney, T., Venkat, A., Wang, D., Pope, T., Aberger, K., Gordon, B., Ahuja, N., Carlson, J., Milliron, M., Hart, K., Gilbertson, C., Wilson, J., Mueller, L., Brown, L., & Gordon, B. (2017). TRIAD VIII: Nationwide Multicenter Evaluation to Determine Whether Patient VideoTestimonials Can Safely Help Ensure Appropriate Critical Versus End-of-life Care. Journal of Patient Safety, 13 (2), 51-61. https://doi.org/10.1097/PTS.0000000000000357