Table 3.

Summary of Selected Papers

Reference	Aims	Theory	Study Design	Setting	Sample Size (N)	Intervention	Outcome measures and results	Theme	Video Content, duration
Aslaks on, et al. (2019) (13)	To evaluate if ACP videos could be integrated into surgical care and if patients would engage in perioperative ACP discussions after the intervention	None	RCT with recorded interviews	Single-center, Tertiary care, Academic Hospital-Across US	92 patients undergoing major cancer surgery I= 45 C= 47	I: ACP video featuring a patient and her family undergoing preoperative and postoperative issues C: Informational video about surgery program	No difference in discussion of ACP content nor in patient-centeredness between groups HADS remained stable Participants categorized video as helpful 41% (vs. 39%)	Effect on preference and ACP	Patient and family discussing preparing for, undergoing and recovering from major surgery and recommen ding ACP 6-minutes
Brown, et al. (1999) (14)	To assess if the addition of video tape would stimulate ACP completion more than written materials alone	Communication theory: Video increases knowledge allowing informed consent.	RCT	Community dwelling – in Colora do	1247 patients randomized I = 619 C = 638	I: Peace of Mind videotape + Written-materials C: Written-materials only	ACP completion after 3 months 34% of study population had at least one ACP, compared with 20% at baseline. No difference found between the groups.	Effect on preference and ACP	9 interviews of patients and families describing their feelings and choices about ACP unknown
Capewell, et al. (2010) (38)	To determine the feasibility of evaluating a DVD based educational intervention among cancer patients	System theory: Barriers to cancer pain include patient, professional and HC system levels.	Prospective	Community dwelling – in United Kingdom	15 patients and 10 caregivers	Baseline (V1): 6-min DVD-based educational video with researcher. Participants received a takehome DVD copy and leaflet. At 5–10 days (V2): Second visit/questi onnaire At 25–35 days (V3): Third visit/questionnaire	Patient pain questionnaire (PPQ) Reduction of 18% between V1 and the final assessment V2 or V3 (p=0.007) No significant improvements between V2 and V3(p= 0.067) Brief pain inventory (BPI) Reduction of 9.6% between V1 and V2 (p=0.0 2) Hospital anxiety/Depression Scale (HAD) No significant changes Family Pain questionnaire (FPQ) Knowledge subscale improved by 42% between V1 and V3.	Information aid	Multi-disciplinary palliative care staff talking about cancer pain and opioid use 6-minutes
Chung et al. (2016) (39)	To find a development strategy for a culturally credible video with emphasis on Hispanic hospice patients	Communication theory: Communication between patient and provider is best method to deliver information to Latinos. Video can help clinicians communicate with Latinos.	Focus group	Comnunity dwelling - Hospice - in California	78 Latino caregivers: Phase 2 = 47 Phase 3 = 12	I: Video about a patient with Alzheimer’s disease, her family caregivers and healthcare providers	Video’s educational effectiveness, strength and weaknesses Phase 2: Request for more powerful shots that facilitate virtual engagement and for additional information about hospice enrollment. Phase 3: Caregivers stated that video will increase awareness of hospice availability	Satisfaction and acceptance of video	Latino family’s personal testimonial of caring for Mexican-American with late stage Alzheimer Dementia and bilingual interdisciplinary hospice team member stories about hospice <10-minutes
Cohen, et al. (2018) (15)	To understand the relationship of proxy level of care preferences and documented ACP in the EVINCE cohort; To evaluate how does ACP video improve concordance between care preferences and patterns of advance directives	Self-efficacy theory	Cluster RCT	Multi-center, Nursing home facilities - in Boston	328 resident-proxydyads I= 172 C=156	I: description + 12- minutes video on tablet showed to proxy C: Description of three levels of care options	Concordance between proxy level of care preferences and ACP documented in residents charts When proxies stated intensive care preference, 58% of residents’ charts were deemed to be concordant with that preference; When comfort care was preferred, residents in the intervention arm were more likely to have directives concordant with preference compared to control (AOR= 2.48, CI 1.01-6.09)	Effect on preference and ACP	Visual images of the 3-part goals of care choices in advance dementia: life prolonging care in the ICU with simulated resuscitation, basic medical care in medical ward, and comfort care on home hospice 12-minutes
Cruz-Oliver, et al. (2016) (35)	To assess the effectiveness of educating Latinos using telenovel as about CG stress and improve their attitudes towards using EOL care	None	Pre-posttest survey to CGs	Community dwelling - Across US	145 caregivers	Audiovisual Intervention using telenovela and Power Point presentation	Knowledge and Attitudes Post-video higher awareness of CG stress and were more willing to accept help from hospice, social work, adult day care and chore worker. 6-month post-intervention survey/follow-up 91% said they most probably intended to use these services	Informtion aid	Bilingual telenovela about a caregiver struggling to care for her father with dementia and how healthcare providers help her keep patient at home 15-minutes
Cruz-Oliver, et al. (2018) (36)	To identify the motives of CGs to participat e in educatio nal intervent ion and to evaluate their learning outcome	None	Pre-posttest survey to CGs	Community dwelling - Across US	145 caregivers	Telenovela and Power Point presentation	Pretest 2-open ended questions about expected learning Most (75%) expected to learn how to help the sick Post-test learning assessment Participants left the training with better understanding about how to accept help (45%) and the services available (46%)	Information aid	Bilingual telenovela about a caregiver struggling to care for her father with dementia and how healthcare providers help her keep patient at home 15-minutes
Deep, et al. (2010) (16)	To determine if the video images of a patient with advanced dementia impact informed decisions about future care.	Self-efficacy theory: Video communication leads to increased knowledge and self-efficacy.	Cross - sectional structured interviews	Outpatient clinic - in Boston	120 patients	I: A 2-minute documentary video of a patient with advanced dementia C: Verbal description	Post-video reasons for change in choice of care: Medical care inherently good, avoid suffering, Inadequate QOL, Not become a burden to family, futile treatment, preserve life Post-video change in preference of care 18/25 change d from life-prolon ging to comfort; 16/22 changed from limited to comfort t; 3 themes on the impact of the video: Value of the visual as oppose d to words, imparti ng knowle dge about experie nce & emotio nal reactio n to video.	Effect on preference and ACP	Two daughters talking to the patient with dementia 2-minutes
El-Jawahri, et al. (2010) (17)	To determine the preference of care of cancer patients after a video intervention	Communie ation theory: These interventions maybe difficult for patients to imaging using verbal description alone. Video images have been shown to improve understanding of complex health info and inform decision-making.	RCT	Oncology elinie - in Boston	50 glioma patients I= 23 C= 27	I: 6-min video plus verbal narrative C: Verbal narrative	GOC preference of care assessment 91% of participants in the video group preferred comfort (life-preserving 0%, basic 4%, and uncertain 4%)	Effect on preference and ACP	Visual images of the 3-part goals of care framework in advance cancer: life prolonging care in the ICU with simulated resuscitation, basic medical care in medical ward, and comfort care on home hospice 6-minutes
El-Jawahri, et al. (2016) (18)	To assess the effectiveness of a video-assisted intervention compared to a verbal description in patients choosing comfort care	Communication theory: Video-assisted approach was designed to stimulate and supplement the conversation with clinicians. Patients can be empowered to engage clinicians in ACP, strengthening discussions with providers.	RCT	Single-Center Aeade mie Hospital - Aeross US	246 patients > 64 yrs old: I = 123 C = 123	I: Verbal Narrative plus 6-minute GOC video for patients with advanced heart failure C: Verbal Description only Control arm	GOC preferences 51% participants in the video intervention preferred comfort care, to forgo CPR/Intubation and had higher ACP knowledge Follow up conversation At 3 month, 61% (vs. 15% in control) had GOC conversation with health care provider	Effect on preference and ACP	Doctor introduces ACP and 3-part goals of care framework, followed by simulated code with clinicians conducting CPR and intubation 6-minutes
Epstein, et al. (2015) (19)	To assess the impressions of a CPR educational video for cancer patients	Communication theory	Interview of participants in a RCT	Outpatient oncology clinic - in New York	54 patients I= 29 C= 25	I: Educational 3-minutes video about CPR C: Narrative description	Answers to open-ended question about post-intervention concerns Advance care planning should be started early, information about the process of CPR affirmed values, participants were apprehensive about ACP but wanted to discuss it, gaps in medical knowledge emerged, CPR information was helpful/accept able, physicians should be involve d in ACP. While sometimes difficult to discuss, ACP was deemed a helpful and desired process. They believed that the process ideally should be begin early, involve clinicians, and that video educati on is an appropriate and affirming conversation starter.	Effect on preference and ACP	Visual images of the 3-part goals of care framework in advance cancer: life prolonging care in the ICU with simulated resuscitation, basic medical care in medical ward, and comfort care on home hospice 3-minutes
Epstein, et al. (2013) (20)	To compare the effect of a video intervention versus a narrative description to enhance the completion of ACP and documented discussio n about desired EOL care	Communication theory	RCT	Single-center, Out-patient oncology clinic - in New York	57 cancer patients I= 30 C= 26	I: Short 3-min CPR and mechanical ventilation video C: Narrative description of CPR - script identical to the one heard in the video	ACP completion 40% (12/30) of patients in the video arm completed ACP vs. 15% (4/26) in narrative arm (p=.07) Preferences for CPR changed significantly in the video arm (p=.02 3) and not in the narrative arm	Effect on preference and ACP	Visual images of the 3-part goals of care framework in advance cancer: life prolonging care in the ICU with simulated resuscitation, basic medical care in medical ward, and comfort care on home hospice 3-minutes
Gallagher-Thompson, et al. (2010) (27)	To determine if a Skill-DVD compared to Educational-DVD about dementia patients would be effective in reducing depressive symptoms & stress related to CG (CES-D & pos affect) of Chinese dementia patients	Self-efficacy theory: Build skills and self-efficacy to improve outcomes	RCT	Community dwelling - Across US	76 caregivers: I = 40 C=36	I: Skill training DVD intervention (SKDVD) C: Education DVD intervention (EDDVD)	CES-D decreased depressive symptoms in both groups post video Positive Affect subscale score increased significantly in skill-DVD (p=0.0 01) RMBPC Stress/negative reaction toward patient behavior decreased more in the skill-DVD group (p=0.0 19)	Emotional support	Narrator explains information about dementia, caregiver stress, how to communicate and access resources in Mandarin 2.5 hours
Gant, et al. (2007) (26)	To determine the efficacy of video intervention in reducing psychosocial distress in male caregivers	None	RCT of male caregivers	Community dwelling - Urban Midwest	32 male caregivers: I =17 C =15	I: Video/Workbook/telephone coaching C: 37-page booklet Basic Dementia Care Guide + biweekly phone calls	RMBPC Significant reduction in caregiver upset and annoyance across both the booklet/check-in calls and the video/coaching intervention Video intervention greater efficacy not demonstrated Self-efficacy Scale, Positive/negative emotions Greater efficacy of video intervention not demonstrated	Emotional support	Unknown specific content, but it was based on Dementia Caregiving Skills Program Unknown
Hanson, et al. (2017) (33)	To verify if GOC video intervention can improve communication and decision making as well as acceptance to palliative care for advance dementia patients and family decision makers	None	Cluster RCT	Community dwelling - nursing home - in North Carolina	I = 151 dyads C = 151 dyads	I: Family decision makers had two-part intervention consisting of an 18-min. Goals of Care (GOC) video plus a discussion with the nursing home care team. C: Informational video and Usual care plan	Quality of communication score Improv ed End-of-life communication (QOC) scores compar ed to control at 3 months and at end of the study Concordance with clinicians GOC Greater concor dance with providers ACP problem score No difference in ACP problem score Quality of Palliative Care Hospital transfer and survival time did not differ significantly	Decision aid	On dementia, goals of prolonging life, supporting function, or improving comfort, and how to prioritize goals 18-minutes
Kozlov, et al. (2017) (37)	To evaluate if laypersons’ knowledge about palliative care improve with brief, self-administrated educational intervention compared to written page	Communication theory: Patient knowledge of health services drives utilization Patients are not able to make fully informed treatment decisions when they are unaware of all the care options available.	RCT	Multi-Center both Acade mic & Community Hospitals - in Missouri	152 laypersons I = 77 C = 76	I1: Video Intervention about palliative care C1: Information page intervention I2: Diet video C2: Information page control	Palliative care Knowledge Scale & Mean confidence ratings (PaCKs) No significant difference was found in the knowledge scores and confidence in knowledge between the video-intervention and the information-intervention groups.	Information aid	Doctor giving information about palliative care, scenes of doctor interacting with patients 3-minutes
Lambing, et al. (2006) (43)	To evaluate how can seriously ill patients that received a CD-ROM intervent ion feel with the educational program	Self-efficacy theory	Prospective pilot	Single-center Academic Hospital - in Michig an	50 patients diagnosed with life- limiting illness	Pre-intervention questionnaire, ‘Completin g a Life’ CD-ROM, Post-intervention questionnaire	Comfort level with information provided 90% somewhat comfor table using CD ROM 98% found it easy to use	Satisfaction and acceptance of video	Information in taking charge, finding comfort, reaching closure and personal stories of patients with terminal illness 1 hour
Leow and Chan (2016) (42)	To evaluate the perception of CGs of advanced cancer patients after receiving a video intervention, having telephone follow-ups and participating in online forum	Communieation theory	Semi-struetured face-to-face interviews	Single-center Home Hospice - in Singap ore	12 caregivers of patients with advanced cancer	I: 6-week psychoeducational intervention ‘Caring for the CG’ program that includes: 1 23-min video, 2-Telephone follow-up 3-Online social support	2 open ended questions about perception and most/least useful component Most (10/12) participants found it most useful; Most particip ants said they ‘identify with the scenes in the video’ relating to the frustrations the CG in the video was experiencing	Satisfaction and acceptance of video	Unknown specific content, but it is based on Caring for the Caregiver Program psychoeducational intervention 23-minutes
Matsui (2010) (21)	To find the preference of care of Japanese older adults after an educational program	None	Quasi-experimental	Community dwelling - in Japan	121 adults (>65 years old)	I: 90-min educational program consisting of a lecture, video about EOL care in hospice and discussion C: Handouts	Post-video life sustaining treatment preferences Regarding artificial nutrition changed from 46% to 25% in the category “leave it to physicians” Attitudes about Advanced Directives Positive attitudes about Advanced Directives increased 1 month post-video from 43% to 52% (p=.02 4) Acceptability Program acceptance was higher in the intervention group (8.6 vs. 7.5, p=.011 ) 1-mo post video discussion with physician about preferences of care 49% (from 29%)stated that they would not prefer artificial nutrition and this remained 1 month follow-up (p<.010)	Effect on preference and ACP	The video introduced public preferences for life sustaining treatment, actual EOL care in a hospice at home and in the NH and living wills produce by the Japan Society for Dying with Dignity 90-minutes
McIlvennan, et al. (2018) (32)	To determine if a DT-LVAD could be effective in improving shared decision making for caregivers	Communication theory	Stepped-wedge RCT	Multi-Center both Academic & Comm unity Hospitals - Across US	182 caregivers I=71 C=111	I: 1-Delivery of an in-person 2.5h clinician-directed decision support training of local staff; 2-Integration of 26-min video and 8-page pamphlet about decision aids C: Formal industry pamphlets, videos and program-specific LVAD documents	Decision Quality-Knowledge no change in quality - knowledge between groups Values-choice concordance At 1-month concordance between values and treatment choice was higher in the intervention group (p=0.0 26) but not at 6mo (p=0.0 8)	Decision aid	Decision Aid for patients and their caregivers considering DT-LVAD 26-minutes
Pensak, et al. (2017) (40)	To determine the acceptability, anticipated usability and feasibility of Pep-Pal = a mobilized adapated version of PEPRR=Psycho-Educational, Paced Respiration and Relaxation Program	Self-efficacy theory	Focus groups and individual interviews	Single-center, Academic Hospital - in Colora do	Focus group= 6 Interview= 9	Focus group of Step 2 with 6 CGs: Pep-Pal 10-min mock-up video Interview of Step 2 with 9 CGs: Pep-pal videos	Focus group quotes based on 5 outcomes: Majority preferred combination of animated and human delivery, suggested to include more positive examples, could use video in the waiting room, include breathing exercises, and that a website will be great. Interviews subthemes: Distractions, validating the CG experience, combination of 1:1 support, no difficulty, an acceptable way to get support prognosis introduction early on diagnosis	Satisfaction and acceptance of video	Introduction to stress management, mind-body connection, how our thoughts can lead to stress, strategies for maintaining energy and stamina, comping with uncertainty, managing relations and coping with your needs, getting the support you need, and improving intimacy. 9 videos of 10-minutes each
Schofie, et al. (2007) (29)	To assess the effect of this DVD on cancer patients’ pretreatment anxiety, informational needs and self-efficacy	None	Quasi-experimental	Single-center, Oncology clinic – in Australia	100 patients with cancer (>18 years old)	I: Take-home DVD about receiving chemother apy and self-management of common side effects C: Usual care	Satisfaction Intervention group more satisfied (p=0.0 26) HADS No significant difference between the usual care and the intervention groups Self-perceived palliative vs. Self-perceived curative patients Curative patients rated themselves as more confident maintaining activity / independence, stress management, accepting cancer/maintaining positive attitude affective regulation and seeking social support	Emotional support	Focused on preparation for receiving chemotherapy and self-management of eight common side effects 25-minutes
Steffen (2000) (28)	To evaluate the usefulnes s of a CG anger-management intervention ingroup or at home	Self-efficacy theory	RCT	Community-dwelling - in Boston	33 caregivers of dementia patients I1= 10 I2= 9 C= 9	I1: 1-Home-based viewing of an anger-management video segments for the next 8 weeks and a workbook plus 20- min weekly telephone checks I2: Class-based meeting with a trained facilitator C: Wait-list participants	Anger intensity anger scores for the two intervention conditions were each significantly lower than in the posttre atment Wait-list group (p<.01) BDI Mean BDI for the home-based viewin g condition was significantly different than waitlist (p<.01)	Emotional support	Narrator present specific components, brief interviews with caregiver and an enacted role-play of assertion skills 4 hours
Steffen and Gant (2015) (30)	To evaluate the effect of a basic education/telephone support condition vs. video instruction/telephone support condition on reducing negative behaviors, depression, and negative moods	None	RCT - single blind	Community dwelling – Across US	74 caregivers I=33 C=41	I: Video instruction/workbook/telephone behavioral coaching C: Basic education/telephone support	RMBPC Behavioral upset significantly reduced with medium effect at 10 weeks, but at 6-months post intervention remain similar between both groups BDI-II Greater efficacy of the behavioral coaching in reducing depressive symptoms (p<0.0 5) Negative mood Lower level of negativ e mood and anxiety in the behavioral coaching group	Emotional support	Narrator explains behavioral activation, management of disruptive dementia behaviors, relaxation during caregiving and self-efficacy 5 hours
Thomas, et al. (2015) (41)	The determine how a multimedia DVD for CGs meet informational needs and provide peer support	Self-efficacy theory	Focus group and interviews with caregivers	Community dwelling – in Australia	29 caregivers	CGs received a DVD multimedia sent by mail and a questionnaire to complete.	Rating scale on helpfulness, on satisfaction and how well they related to media CGs stated they were satisfied, that the DVD was a positive tool (realistic, informative, interesting, inspiring) to introduced palliative care to caregivers CGs related well with the film	Satisfaction and accept ance of video	Interview about self-care, social support, palliative care, EOL discussions and bereavement. Unknown
Toraya (2014) (22)	To assess if an educational AD video is effective in increasing patient understanding regarding discussion of future HC wishes and AD documents	Communication theory: communication is an important part of ACP and videos facilitate communication.	Pre-post survey	Single-center community Hospital outpatient clinic – in Washington	45 participants from outpatient clinics	I: 12-minute video to encourage discussion about Advanced Directives	Changes in future HC wishes 58% said video changed their HC wishes Rating of the video helpfulness Mean rank of video helpful ness was 8.8 (0–10)	Effect on preference and ACP	Video encourages discussions about future healthcare wishes and ACP 12-minutes
Volandes, et al. (2008) (23)	To assess the influence of Health Literacy as opposed to race in EOL care preferences after video intervention	Communication theory: Health literacy is barrier to communication and educational video can assist	Cross sectional questionnaire	Outpatient clinic - Urban and Suburb an Boston	144 participants/patients AA=80 W=64	I: Verbal description followed by 2-min video of a patient with dementia. Participant s were evaluated on their health Literacy	Tool used to measure health literacy of each participants Preferences of care after hearing verbal description 67% of low health literacy participants preferred aggressive care HL remained significant and independent predictor of preferences for care (OR 7.1, 95 0 CI 2.1-24.2) Comparison with preferences of care after video Majority of subjects across both races and all health literacy groups chose comfort care after viewing the video. The distribution of subject’s preferences changed significantly (p=0.0001).	Effect on preference and ACP	Narrator describes the salient features of advanced dementia. 2-minutes
Volandes, et al. (2008) (25)	To determine if patients’ preferences for EOL care can be independently predicted by educational level after hearing verbal description of advance dementia To evaluate a video decision aid about advance dementia effect on communication barriers posed by limited educational level	Communication theory	Cross sectional - questionnaire	Outpatient clinic - in Boston	104 Latino patients	I: Verbal description about preferences of care followed by 2-min video of a patient with dementia	Preferences of care Pre/post video intervention Before video 40% preferred comfort care and after the video 75% preferred comfor t care After watching the video differences by education disappeared	Effect on preference and ACP	Narrator describes the salient features of advanced dementia. 2-minutes
Volandes, et al. (2009) (31)	To assess if patients & surrogates that viewed a video decision-support tool for advance dementia concur more about EOL preferences compared to those receiving a verbal description	Communication theory: The video engages and allows both patients/surrogates to envision future health states in a manner not captured with verbal communication.	RCT	Single-Center Community Hospital - in Boston	14 patient-surrogate dyads: I= 8 dyads C=6 dyads	I: Verbal narrative plus viewing a 2-minute video decision-support tool C: Verbal narrative of advanced dementia	Surrogates preferences for their loved one There was 100% concordance of surrogates and patients preferences Knowledge scores for dyad Increased for both groups, but higher in the intervention	Decision aid	Two daughters talking to the patient with dementia 2-minutes
Volandes, et al. (2011) (34)	To evaluate if rural patients would be more likely to prefer comfort care after a video decision aid	Communication theory-Video can communicate informatio n to support decision making	RCT	Outpatient clinic - Rural Louisiana	77 advanced dementia patients I=33 C=43	I: Verbal narrative followed by a Video decision aid C: Verbal description only	Difference in proportions of subjects preferring comfort care between the groups 91% in the video group vs. 72% in the verbal description group (p=.04 7) Factors associated with preference for comfort care white, female, video arm and higher HL (P<.05)	Decision aid	Two daughters talking to female patient with advance dementia and visual images of the 3-part goals of care framework : life prolonging care in the ICU with simulated resuscitation, basic medical care in medical ward, and comfort care on home hospice 6-minutes
Volandes, et al. (2012) (24)	To assess the effect of reinforcing verbal description with video in order to improve knowledge about CPR; To determine if there is a difference on stated preferences after watching the video	Communication theory	Cross sectional	Oncology clinic - in New York	80 patients with advanced cancer	I: Verbal description followed by 6-min video describing 3 choices of HC (life-prolonging, basic, comfort care)	Pre/post: Preference of Care After verbal description, 36% preferred comfort care Did not change significantly after viewing the video CPR/ventilator preferences CPR/v entilator preferences changed significantly (61% pre, 71% post video, p=0.03)	Effect on preference and ACP	Visual images of the 3-part goals of care choices of health care in advance cancer: life prolonging care in the ICU with simulated resuscitation, basic medical care in medical ward, and comfort care on home hospice 6-minutes

RTC = Randomized Controlled Trial, I = Intervention, C = Control, CG = caregiver, CES-D = Center for Epidemiological studies Depression Scale, RMBPC=revised memory and behavior problems checklist, GOC = Goals of care, HAD= Hospital Anxiety and Depression Scale, PPQ= Patient Pain Questionnaire, BPI= Brief Pain Inventory, QOL = Quality of Life, AA= African Americans, W= Whites, REALM= Rapid Estimate of Adult Literacy in Medicine tool, HL= Health Literacy, HC= Healthcare, CG= caregiver, BDI-II= Beck Depression Inventory over the past two weeks, LVAD= Left Ventricular Assist Device, ACP= Advanced Care Planning, EOL= End-of-life, ACP= Advance Care Planning, US= United States