Wednesday, December 12, 2012

By Andrew M. Seaman

NEW YORK (Reuters Health) - Dying cancer patients are less likely to want aggressive end-of-life care if they watch a short video about CPR than if they simply hear about it, according to a new study.

"These are huge differences. You will die very differently if you watch the video than if you don't," said Dr. Angelo Volandes, the study's lead author from Boston's Massachusetts General Hospital.

"All these patients had a terminal condition. It's not like there was another treatment they were trying...So (CPR) was prolonging the dying process," he said.

The researchers found in a group of 150 cancer patients, who were thought to have less than a year to live, 48 percent wanted CPR after being told about it, compared to 20 percent in the group who also watched a video showing compressions on a dummy and the inserting of a breathing tube.

"It's one of the most important issues in American medicine today. People are getting medical interventions that, if they had more knowledge, they would simply not want," said Volandes.

The new study builds off previous research with similar findings by the same group. The earlier research, however, was only conducted with brain cancer patients at one medical center.

For the new study, published in the Journal of Clinical Oncology, the researchers included a wider variety of cancer patients at four medical centers in Massachusetts, New York and Tennessee.

All of the patients who agreed to participate in the study were read a standardized description of CPR -- described as pressing on their chest and using an electric shock to "get your heart to beat again if it stops."

The description also said CPR does not revive most patients with advanced cancer, and the patient would likely be put in the ICU with a breathing machine if it worked.

The researchers then randomly selected 70 of the patients to watch a three-minute video demonstration.

In the group that was only told about CPR, about half of the 80 patients said they wouldn't want doctors or nurses to revive them. That compared to 79 percent of the patients who also watched the video.

Nine out of every ten patients who watched the video also said it was "helpful."

PART OF A BIGGER CONVERSATION

Volandes told Reuters Health that the video may reinforce the information patients usually get from their doctors.

"People aren't clinicians. They don't have clinic experience to understand what this looks like," he said.

Dr. Susan Gaeta, an assistant professor at The University of Texas MD Anderson Cancer Center in Houston, told Reuters Health she likes the idea of using the videos, but said they need to be part of a bigger conversation.

"What we're trying to do is to have conversation with patients on what their goals and values are," said Gaeta.

She added that the question should not be, "Do you want this?" It should be, "Is this medically appropriate based on your goals and values?"

Volandes said their collection of 25 videos on various topics, including CPR and breathing tubes, are used by over 30 healthcare systems across the country.

Gaeta added that her hospital is developing their own videos that incorporate their focus of goals and values.

SOURCE: http://bit.ly/TP4qV1 Journal of Clinical Oncology, online December 10, 2012.

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