Navigating conversations about end-of-life care preferences, particularly concerning cardiopulmonary resuscitation (CPR) and intubation, presents significant challenges for patients with advanced heart failure. To address this, a study investigated the effectiveness of advance care planning tools, specifically a video decision support tool combined with a patient checklist, in improving these crucial discussions.
This research, a randomized controlled trial conducted across multiple sites, involved 246 patients aged 64 and older diagnosed with heart failure and facing a high risk of mortality (greater than 50% within 2 years). Participants were divided into two groups: an intervention group and a control group. The intervention group received a verbal explanation of different goals of care – life-prolonging care, limited care, and comfort care – and information about CPR/intubation. Crucially, they were also provided with a 6-minute video illustrating these care levels and CPR/intubation procedures, alongside an advance care planning checklist to guide their decision-making process. The control group, in contrast, only received the verbal explanation of care options.
The study’s primary outcome was to compare the proportion of patients in each group who preferred comfort care immediately following the intervention. The results were striking. In the intervention group, a significant 51% of patients opted for comfort care, while only 30% of the control group chose this option (P<0.001). Furthermore, patients in the intervention group demonstrated a greater inclination to forgo aggressive interventions. 68% of intervention participants chose to forgo CPR compared to only 35% in the control group (P<0.001), and similarly, 77% versus 48% decided against intubation (P<0.001). Beyond preference, the video and checklist also enhanced patient understanding, with intervention participants achieving significantly higher mean knowledge scores (4.1 versus 3.0; P<0.001) on a 6-item knowledge test.
The findings clearly indicate that utilizing advance care planning tools, such as video decision aids and patient checklists, significantly empowers heart failure patients in making informed decisions about their end-of-life care. These tools not only improve patient knowledge but also encourage a shift towards comfort-focused care, aligning treatment decisions with patient values and preferences. By facilitating a deeper understanding of care options, these advance care planning tools play a vital role in ensuring patient-centered care for individuals facing advanced heart failure.
Clinical trial registration: URL: http://www.clinicaltrials.gov. Unique identifier: NCT01589120.
