Randomized Controlled Trial of an Advance Care Planning Video Decision Support Tool for the General Population

Abstract

Background: Randomized controlled trials of decision aids for advance care planning (ACP) usually investigated patient groups' end-of-life (EOL) care preferences. This study evaluated the effectiveness of video decision-support materials for ACP in the general population to extend the potential application of ACP. Methods: This was a randomized, open-label, parallel-group, comparative effectiveness trial. We used computer-generated simple randomization (1:1) to randomize participants stratified by age and sex. Allocation was open-label. Participants assigned to the intervention arm viewed a 20-minute decision support video for ACP, and those in the attention-control arm received a 13-page brochure for advance directives. The primary outcome was change of ACP preference, established if the difference of changes between the two groups was greater than 15 percentage points (e.g., intervention 25%, attention-control 10%) at post-intervention compared with baseline assuming three different clinical conditions: healthy, diagnosed with a serious illness and diagnosed at EOL. Findings: From April 27 to May 25, 2018, we enrolled 250 of 832 contacted eligible participants (aged ≥20 years and healthy) and randomly assigned half to the video-assisted intervention group and half to the attention-control group. At post-intervention, ACP preference was significantly higher in the video-assisted intervention arm under all three hypothetical circumstances: healthy (p=0.008; Δ=14.4%); diagnosed with a serious illness (p=0.014; Δ=14.4%); diagnosed as at EOL (p=0.001; Δ=17.6%). A preference for no CPR at EOL significantly increased in the intervention group (p=0.024); in the subgroup with no ACP preference, preference for active treatment was significantly reduced in the intervention arm in two subsets (diagnosed with serious illness and EOL). Interpretation: A well-constructed, video-assisted decision support intervention can increase ACP preference in the general population that presumably had little opportunity to discuss ACP with medical staff. Funding Statement: Grant from the Korea Health Technology R&D Project through the Korea Health Industry Development Institute (KHIDI), funded by the Ministry of Health & Welfare, Republic of Korea (grant number: HC15C1391). Declaration of Interests: The authors declare no competing interests. Ethics Approval Statement: The protocol was approved by the institutional review board in Seoul National University Hospital Clinical Research Institute (IRB No 1804-083-937).