Use of Video Decision Aids to Promote Advance Care Planning in Hilo, Hawai‘i

• Published in: Journal of general internal medicine : JGIM 2016-09, Vol.31 (9), p.1035-1040
• Main Authors: Volandes, Angelo E., Paasche-Orlow, Michael K., Davis, Aretha Delight, Eubanks, Robert, El-Jawahri, Areej, Seitz, Rae
• Format: Article
• Language: English
• Subjects: Advance directives; Aids; Documentation; Health care; Health care facilities; Internal Medicine; Intervention; Medical personnel; Medicine; Medicine & Public Health; Original Research; Patients; Physicians; Primary care; Program evaluation; Quality control
• ISSN: 0884-8734; 1525-1497
• DOI: 10.1007/s11606-016-3730-2

Introduction Advance care planning (ACP) seeks to promote care delivery that is concordant with patients’ informed wishes. Scalability and cost may be barriers to widespread ACP, and video decision aids may help address such barriers. Aim Our primary hypothesis was that ACP documentation would increase in Hilo after ACP video implementation. Secondary hypotheses included increased use of hospice, fewer deaths in the hospital, and decreased costs in the last month of life. Setting The city of Hilo in Hawai‘i (population 43,263), which is served by one 276-bed hospital (Hilo Medical Center), one hospice (the Hospice of Hilo), and 30 primary care physicians. Program Description The intervention consisted of a single, 1- to 4-h training and access to a suite of ACP video decision aids. Program Evaluation Prior to implementation, the rate of ACP documentation for hospitalized patients with late-stage disease was 3.2 % (11/346). After the intervention, ACP documentation was 39.9 % (1,107/2,773) ( P