Table 1.
Summary Overview of Studies (n = 38)a
| Author, year, country of origin | Population | Study design | Intervention technology | Control | Results |
|---|---|---|---|---|---|
| Cancer | |||||
| Epstein et al., 2013, U.S. | Patients with progressive pancreas or hepatobiliary cancer (n = 56) | RCT | Educational CPR video about ACP (n = 30) | Verbal CPR narrative about ACP (n = 26) |
Rates of ACP documentation: Improved significantly in intervention armKnowledge re CPR & ACP: Increased in both armsPreferences re CPR: Decreased in intervention arm but not in control arm Preferences re mechanical ventilation: No change in either arm |
| Gustafson et al., 2013, U.S. | Patients with nonsmall cell lung cancer & their caregivers (n = 285 dyads) | RCT | Online support system (Comprehensive Health Enhancement Support System - CHESS) w information, in-site social networking & communication, decision support tools (n = 144) | Use of Internet & list of Internet sites about lung cancer (n = 141) |
Patient Symptom Distress: Significantly decreased in intervention arm |
| Pelayo-Alvarez et al., 2013, Spain | Patients with advanced cancer requiring palliative care (n = 169 MDs, 117 patients) | RCT | 96 hour online palliative care education program (n = 85) | 20 hour, face-to-face training course (n = 84) |
Patient pain & symptom control: Significantly improved in intervention arm Family anxiety: Significantly lower in intervention arm Caregiver satisfaction: No change Knowledge of MDs: Significantly increased in intervention arm Attitude of MDs: No change |
| Temel et al., 2013, U.S. | Patients with incurable lung cancer (n = 181) | Pre-post | E-mail prompt timed to treatment events (n = 98) | Usual care (hist. controls) (n = 83) |
Clinician documentation of code status in EHR: Significantly increased in intervention arm Mean time to code status documentation in EHR: Significantly decreased in intervention arm |
| Vogel et al., 2013, U.S. | Women with ovarian cancer (n = 35) | RCT | Prototype website to help patients monitor distress, record questions for providers, access information, set goals, tailored to disease stage & learning style (n = 20) | Control website (n = 15) |
Completion of AHD: No change Palliative care consultation: No change Decisional conflict: Improved in intervention arm |
| Volandes et al., 2013, U.S. | Patients with advanced cancer (n = 150) | RCT | Video decision support tool depicting patient on ventilator & CPR performed on simulated patient (n = 70) | Verbal narrative describing CPR (n = 80) |
Preference for CPR: Significantly lower in intervention arm Knowledge of CPR: Significantly increased in intervention arm |
| Watanabe et al., 2013, Canada | Rural patients with advanced cancer (n = 44) | Pre-post | Videoconferencing for patients at rural health care facility (n = 44) | Reflexive |
Patient anxiety: Significantly improved Patient appetite: Significantly improved Cost in time, distance traveled, & dollars: Significantly reduced |
| Volandes et al., 2012, U.S. | Patients with advanced cancer (n = 80) | Pre-post | Educational video (n = 80) | Reflexive |
Goals of care preference: No change CPR preference: Decreased Knowledge re goals of care: Increased |
| Green, Levi, 2011, U.S. | 2nd year medical students (n = 121) & patients with cancer (n = 121) | Pre-post | Computer-based multimedia decision aid designed to help patients w ACP (n = 60) | Standard advance directive form (n = 61) | Patient satisfaction w ACP methods: Significantly higher in intervention arm |
| Uitdehaag et al., 2011, Netherlands | Patients w new diagnosis of incurable esophageal or head & neck cancer (n = 17) | Pre-post | Audiorecording (CD) of diagnostic consultation, delivery of diagnosis, & discussion of palliative care (n = 10) | Consultation without audiorecording (n = 7) |
Patient QOL: Decreased in intervention arm Patient communication: Improved in intervention arm |
| Yun et al., 2011, Korea | Caregivers of terminally ill patients w cancer & their patients (n = 444) | RCT | Decision aid (video & companion workbook) showing how to discuss terminal prognosis w patient (n = 216) | Decision aid (video & companion workbook) showing pain management techniques (n = 228) |
Decision to communicate: No change Caregivers' decisional conflict: Improved significantly more in intervention arm than in control arm Depression: Improved significantly more in experimental arm than in control arm |
| Capewell et al., 2010, U.K. | Palliative care cancer patients (n = 15) | Interrupted time series | 6 minute video on aspects of cancer pain & use of strong opioids (n = 15) | Reflexive | Patient pain scores: Significantly improved |
| El-Jawahri et al., 2010, U.S. | Patients with malignant glioma (n = 50) | RCT | Video depicting life-prolonging, basic, & comfort care (n = 23) | Verbal narrative on goals-of-care options at EOL (n = 27) |
Preferences for EOL care: None preferred life-prolonging care; significantly fewer preferred basic care; significantly more preferred comfort care in intervention arm Uncertainty re decision making: Significantly higher in intervention arm |
| Duggleby et al., 2007, Canada | Terminally ill cancer patients age ≥60 years (n = 60) | Pre-post | Research-based video & choice of hope activities w instruction by trained RNs (n = 30) | Usual care (n = 30) |
Patient hope: Significantly higher in intervention arm Patient QOL: Significantly higher in intervention arm |
| Nonspecific diagnosis, age ≥65 | |||||
| Volandes et al., 2012, U.S. | Patients age ≥65 years admitted to 2 skilled nursing facilities (n = 101) |
RCT | Video describing goals-of-care options (n = 50) | Verbal narrative (n = 51) |
Patient preferences for comfort care: Significantly higher in intervention arm |
| Volandes et al., 2011, U.S. | Subjects age ≥65 years at rural primary care clinic (n = 76) | RCT | Verbal description of advanced dementia & goals of care & video decision aid (n = 33) | Verbal description of advanced dementia & goals of care (n = 43) | Patient preferences for comfort care: Slightly higher in intervention arm |
| Hamlet et al., 2010, U.S. | Medicare beneficiaries who need EOL care planning (n = 4742) | RCT | Telephone-based education & counseling about AD, palliative versus aggressive care, hospice enrollment; facilitation of interactions with physicians & hospice agencies; referrals to hospice when appropriate; caregiver support (n = 3112) | Usual care (n = 1630) |
Election of less-aggressive care: Significantly higher in intervention arm Increased rate of hospice enrollment: No change Duration of hospice care prior to death: No change |
| Matsui, 2010, Japan | Japanese adults age ≥65 years (n = 121) | Pre-post | Video & lecture using handout (n = 55) | Handout only (n = 57) |
Attitudes towards ADs: Improved slightly in intervention arm Preference for life-sustaining tx by artificial nutrition: Decreased significantly in intervention arm Discussion of EOL preferences w family or HCP: Increased significantly in intervention arm |
| Volandes et al., 2009, U.S. | Older people age >65 years living in the community (n = 200) | RCT | Verbal narrative describing advanced dementia, 2 minute video depicting patient w advanced dementia (n = 94) | Verbal description alone (n = 106) | Election of less aggressive care: Significantly higher in intervention arm |
| Volandes et al., 2009, U.S. | Community-dwelling subjects age ≥65 years & surrogates (n = 28; 14 dyads) | RCT | Verbal narrative & 2 minute video decision support tool depicting patient with advanced dementia (n = 16; 8 dyads) | Verbal narrative describing advanced dementia (n = 12; 6 dyads) |
Patient preferences for comfort care: Significantly higher in intervention arm Concordance of surrogate prediction & patient preferences: Significantly higher in intervention arm |
| Clarke, et al., 2005, U.S. | Senior citizens in community organizations (n = 944) | Pre-post | Mailed flyer offered home-based critical care & AD guide, & individual telephone counseling (n = 839) | Mailed flyer only (n = 105) | Completion of AD: Slightly higher in intervention arm |
| Brown et al., 1999, U.S. | Patients age ≥75 years who used Franklin Medical Office (n = 1247) | RCT | Videotape w illustrated pamphlet, AD forms & guide (n = 619) | Illustrated pamphlet, AD forms & guide (n = 628) | Placement of AD in medical record: Increased in both groups, no significant difference between groups |
| Yamada et al., 1999, U.S. | Veterans age ≥70 years, deemed able to make medical care decisions (n = 117) | RCT | Two handouts on AD & CPR, & 10 minute video about ADs (n = 62) | Handout explaining ADs but not CPR (n = 55) |
Knowledge about AD: Significantly higher in intervention arm Discussion of CPR or AD w HCP: No change |
| Nonspecific diagnosis, other | |||||
| Kannan, Kamalini, 2013, India | Palliative care outpatients (n = 60) | Interrupted time series | SMS text messaging between MDs & patients to manage analgesic adherence & titration for pain relief | Historical data | Doctor-patient communication re pain relief: Significantly increased |
| Sudore et al., 2013, U.S. | Racially & ethnically diverse, low-income adults age ≥60 years (n = 43) | Pre-post | Prototype website guided patients to identify life goals & preferences for medical care & to communicate preferences to surrogate decision makers & physicians | Reflexive | Engagement in ACP behaviors: Significantly increased |
| Takahashi et al., 2012, U.S. | Patients age >60 years w chronic health problems at high risk of hospitalization & ED visits (n = 205) | RCT | Patients relayed biometric & clinical information by telemonitoring to RN. Medical care team communicated with patient via phone or videoconferencing as needed (n = 102) | Usual care (n = 103) |
Hospice enrollment: Increased in intervention arm Mean number of days in hospice: Decreased in intervention arm Time to hospice referral: No difference |
| Deep, et al., 2010, U.S. | Patients age >40 years scheduled to see general internist (n = 120) | Pre-post | Video of patient w advanced dementia | Verbal description of advanced dementia | Patient preferences for comfort care: Significantly increased |
| Kersholt et al., 2009, Netherlands | Members of choirs & music associations (n = 183) | Pre-post | Direct assessment (n = 66), text stories (n = 63), & video (n = 52) to elicit preferences re: location of death at home vs hospice vs nursing home | Reflexive |
Patient preference for home death: Decreased w text & video Patient preference for hospice: Increased w text, decreased w video Patient preference for nursing home: Increased w video |
| Volandes et al., 2009, U.S. | Adult patients age ≥40 years scheduled to see general internist (n = 146) | Pre-post | Video decision aid showing patient w salient features of advanced dementia | Verbal description of advanced dementia | Patient uncertainty re EOL preferences: Decreased |
| Schofield et al., 2008, Australia | Patients scheduled to receive first ever chemotherapy treatment (n = 100) | Pre-post | Educational video on preparing for chemotherapy & self-management of 8 common side effects (n = 50) | Usual care (historical controls) (n = 50) |
Patient self-efficacy for seeking social support: Significantly increased Patient satisfaction w information re side effects: Significantly increased |
| Volandes et al., 2008, U.S. | Spanish-speaking patient of primary care doctors (n = 104) | Pre-post | Two-minute video decision support tool depicting patient with salient features of advanced dementia | Reflexive | Patient preferences for comfort care: Significantly increased |
| Volandes et al., 2008, U.S. | White & African American patients presenting to primary care doctors (n = 144) | Pre-post | Video decision support tool depicting patient with salient features of advanced dementia to help patients overcome low health literacy barriers | Verbal description of advanced dementia |
Low health literacy patient preferences for aggressive care: Significantly decreased Low health literacy patient preferences for comfort care:Significantly increased |
| Penrod et al., 2007, U.S. | Patients at 5 acute care & 3 nursing home sites (n = 3557) | Pre-post | Web-based palliative care report card implemented on network Intranet | Historical data |
Number of PC consults: Significantly increased Percentage of inpatient deaths w PC consultation: Significantly increased Average days betw initial PC consultation & death: Significantly increased |
| Volandes et al., 2007, U.S. | Patients age >40 years scheduled to see general internist (n = 120) | Pre-post | Video decision support tool depicting patient with advanced dementia | Verbal description of patient with advanced dementia | Patient preferences for comfort care: Significantly increased |
| Brumley, et al., 2006, Australia | All adult patients admitted to domiciliary palliative hospice care (n = NR) | Pre-post | One-page information sheet (on MS Word program) updated daily for each pt on computers, faxed to GPs, & downloaded to nurses' PalmPilots | Reflexive | Patient outcomes: Improved |
| Hanks et al., 2002, U.K. | New inpatient referrals to the palliative care team (PCT) (n = 261) | RCT | Telephone & in-person advice & support by PCT (n = 175) | Limited telephone advice only by PCT (n = 86) |
Symptom control: Significantly improved in intervention arm HRQoL: Significantly improved in intervention arm Mood: Significantly improved in intervention arm Emotional bother: Significantly improved in intervention arm |
| Gammaitoni et al., 2000, U.S. | Patients enrolled at university pain clinic (n = 74) | RCT | Telephone-based pharmaceutical palliative care program w specialized prescription services tailored to needs of pain medicine clinical practice (n = 38) | Usual care (n = 36) |
Patient access to medication: Increased Efficient processing of prescriptions: Increased Patient experience of stigmatization: Decreased |
| Ho, et al., 2000, Canada | Patients with HIV/AIDS (n = 140) | Prospective cohort study | AD documents, educational video, & three individual face-to-face counseling sessions | Reflexive |
AD completion rates: Significantly increased Legal validity of completed ADs: Significantly decreased Patient satisfaction w health care: Decreased |