In previous work, the Principal Investigator successfully demonstrated that a video of the goals of care in advanced cancer improved understanding and decision making in a small group of patients with advanced brain cancer. The video presents end-of-life options within the framework of the patient’s primary goals of care (i.e., life prolongation, maintenance of function or comfort care). Building on this earlier work, the main goal of this study is to conduct a randomized controlled trial of the video decision support tool (vs. a verbal narrative) to test the hypothesis that the video improves the decision making process among persons with advanced cancer. Demonstrating the effectiveness of a video in persons with diverse cancers who are actually facing end-of-life decision making represents an essential step in implementing this tool in practice. The specific aims and hypotheses are:
Specific aim 1: To compare the distribution of preferences for the goals of care among 210 subjects with advanced cancer, randomly assigned to one of two ACP modalities: 1) a video visually depicting the goals of care (intervention, 105 subjects) after listening to a verbal narrative of the goals of care; or 2) only a verbal narrative describing the goals of care (control, 105 subjects).
- Hypothesis 1: Subjects randomized to the video intervention will be significantly more likely to opt for comfort care and less likely to choose life-prolonging measures than subjects randomized to the verbal narrative group.
Specific aim 2: To compare knowledge of the goals of care and decisional conflict among 210 subjects randomized to the video (N=105) vs. verbal narrative (N=105).
- Hypothesis 2: Subjects randomized to the video intervention will have greater knowledge and less decisional conflict than subjects in the verbal narrative group.