TRIAD VIII: Nationwide multicenter evaluation to determine whether patient video testimonials can safely help ensure appropriate critical versus end-of-life care

Ferdinando L. Mirarchi*, Timothy E. Cooney, Arvind Venkat, David Wang, Thaddeus M. Pope, Abra L. Fant, Stanley A. Terman, Kevin M. Klauer, Monica Williams-Murphy, Michael A. Gisondi, Brian Clemency, Ankur A. Doshi, Mari Siegel, Mary S. Kraemer, Kate Aberger, Stephanie Harman, Neera Ahuja, Jestin N. Carlson, Melody L. Milliron, Kristopher K. HartChelsey D. Gilbertson, Jason W. Wilson, Larissa Mueller, Lori Brown, Bradley D. Gordon

*Corresponding author for this work

Research output: Contribution to journalArticle

5 Scopus citations

Abstract

Objective: End-of-life interventions should be predicated on consensus understanding of patient wishes. Written documents are not always understood; adding a video testimonial/message (VM) might improve clarity. Goals of this study were to (1) determine baseline rates of consensus in assigning code status and resuscitation decisions in critically ill scenarios and (2) determine whether adding a VM increases consensus. Methods: We randomly assigned 2 web-based survey links to 1366 faculty and resident physicians at institutions with graduate medical education programs in emergency medicine, family practice, and internal medicine. Each survey asked for code status interpretation of stand-alone Physician Orders for Life-Sustaining Treatment (POLST) and living will (LW) documents in 9 scenarios. Respondents assigned code status and resuscitation decisions to each scenario. For 1 of 2 surveys, a VM was included to help clarify patient wishes. Results: Response rate was 54%, and most were male emergency physicians who lacked formal advanced planning document interpretation training. Consensus was not achievable for stand-alone POLST or LW documents (68%-78% noted "DNR"). Two of 9 scenarios attained consensus for code status (97%-98% responses) and treatment decisions (96%-99%). Adding a VM significantly changed code status responses by 9% to 62% (P ≤ 0.026) in 7 of 9 scenarios with 4 achieving consensus. Resuscitation responses changed by 7% to 57% (P ≤ 0.005) with 4 of 9 achieving consensus with VMs. Conclusions: For most scenarios, consensus was not attained for code status and resuscitation decisions with stand-alone LW and POLST documents. Adding VMs produced significant impacts toward achieving interpretive consensus.

Original languageEnglish (US)
Pages (from-to)51-61
Number of pages11
JournalJournal of Patient Safety
Volume13
Issue number2
DOIs
StatePublished - 2017

Keywords

  • Do not resuscitate
  • Living will
  • Patient safety
  • Patient video message
  • Physicians Orders for Life Sustaining Treatment
  • TRIAD

ASJC Scopus subject areas

  • Leadership and Management
  • Public Health, Environmental and Occupational Health

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    Mirarchi, F. L., Cooney, T. E., Venkat, A., Wang, D., Pope, T. M., Fant, A. L., Terman, S. A., Klauer, K. M., Williams-Murphy, M., Gisondi, M. A., Clemency, B., Doshi, A. A., Siegel, M., Kraemer, M. S., Aberger, K., Harman, S., Ahuja, N., Carlson, J. N., Milliron, M. L., ... Gordon, B. D. (2017). TRIAD VIII: Nationwide multicenter evaluation to determine whether patient video testimonials can safely help ensure appropriate critical versus end-of-life care. Journal of Patient Safety, 13(2), 51-61. https://doi.org/10.1097/PTS.0000000000000357