Enhancing Communication About Goals of Care Through Video Interventions

A new study shows that discussions about end-of-life goals can be enhanced with video communication.

In a 2023 study conducted jointly by Harvard Medical School and Massachusetts General Hospital, researchers uncovered a promising strategy to facilitate crucial goals of care discussions among elderly hospital patients. The study revealed that showing patients videos depicting real-life scenarios of such conversations between individuals and clinicians significantly increased the likelihood of their goals being documented. This finding underscores the potential of video interventions in addressing the longstanding challenges faced by both patients and clinicians in navigating these critical discussions.

Understanding Goals of Care Discussions

Before delving into the study’s findings, it’s important to grasp the importance of goals of care discussions within the patient-clinician relationship and their broader implications for healthcare. These discussions typically involve patient, family members, caregivers, and clinicians, aiming to establish the patient’s treatment preferences, particularly in the context of serious, life-threatening illnesses. They  encompass aspects of care such as resuscitation preferences, future care needs, and the level of aggressiveness in treatment plans, aligning the care trajectory with the patient’s values and wishes. Ideally, goals of care discussions should occur before or early in the course of a life-threatening diagnosis, enabling patients, caregivers, and families to confront the realities of the illness and ensure treatment decisions align with the patient’s desires while they are still capable of making informed choices.

Research indicates that patients who engage in end-of-life care discussions with their clinicians often opt for less aggressive treatments, resulting in a more dignified end-of-life experience. Such discussions are the most common reason for inpatient palliative care consultations, and enhance the likelihood that patients receive care aligned with their preferences in their desired end-of-life setting. Moreover, goals of care discussions have been associated with reduced hospital utilization, offering tangible benefits for both patients and healthcare institutions.

Despite these advantages, end-of-life goals of care discussions are frequently overlooked, often due to discomfort from both clinicians and patients in broaching topics related to mortality. Studies have shown that patients want their clinicians to initiate discussions about prognosis and care goals, while clinicians express concerns about causing anxiety by broaching such sensitive subjects. Due to the discomfort, clinicians often struggle with these conversations, frequently overlooking essential questions regarding patients’ care goals.

The Role of Video Interventions: The Study’s Insights

Enter the study, where researchers explored using video interventions displaying goals of care discussions with older hospital patients.

Standard conversations about goals of care often fall short ,while video presentations enhance patient understanding, the study shows.

The study included 10,802 patients aged 65 or older, who were randomly assigned to either watch brief, easily understandable videos illustrating various care options and manners of communicating their goals of care, or receive standard care.

The videos depicted real-life scenarios of patients with serious illnesses engaging in conversations about their care goals, offering tangible examples for viewers to relate to. Results from the study indicated that patients exposed to the video interventions were more likely to have their goals of care documented compared to those receiving standard care.

Notably, the impact of video interventions was greater with minority populations, who are typically underrepresented in goals of care discussions, but showed significantly higher rates of engagement when presented with the videos. The videos were made available in 29 languages, aiding in providing vital care information to those whose first language isn’t English.

Implications and Future Uses

Given the challenges clinicians face in initiating end-of-life discussions, the persistent disparities in documenting end-of-life preferences for ethnic minorities, and the missed opportunities for improved end-of-life care, video interventions emerge as a promising tool to enhance communication and advance patient-centered care. By leveraging multimedia resources to demystify complex healthcare conversations, healthcare providers can empower patients to articulate their preferences, ultimately fostering a healthcare landscape that prioritizes individual dignity and autonomy throughout their healthcare journey.