Capsule Commentary on Volandes et al., Use of Video Decision Aids to Promote Advance Care Planning in Hilo, Hawai’i

Excerpt

Advanced care planning is a shared medical decision tool to assure that care provision is concordant with the patient’s wishes.1 In this study, Volandes and colleagues collaborated with the Hawaii Service Association to implement video decision aids for care planning2 across all islands in the state. In addition, the state included this as a pay-for-quality measure for the state, and providers were eligible for financial incentives for documenting advanced care planning. Not surprisingly, the rate of care planning went up significantly, from 3.2% to 39.9%. Given that the study cohort was patients aged 75 years or older, the surprise isn’t the improvement in care planning, but that this intervention still left over two-thirds of the elderly with no advanced care planning. The authors correctly point out that a study limitation was the lack of tracking to see which providers offered the videos and which patients actually viewed them. While the study had an impressive increase in patients choosing hospice, it is impossible to definitively assess the video’s impact on specific patient behavior. …