Audiovisual Decision Making Essay
In aging patients with severe illnesses, conversation guides and condensed videos can enhance dialogue regarding end-of-life decisions on care between them and clinicians. Research has revealed that in seriously ill aging patients, good communication with clinicians is linked to improved goal-consistent care, increased/enriched quality of life, increased contentment of patients, further and timelier hospital care, better coping on the part of the patient and his/her family, lessened obligation of decision-making for families, and improved grief outcomes. However, research has also shown that many terminally sick (old-age) patients do not engage in timely dialogues regarding their goals, and often, the talks that do take place are deficient.
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Furthermore, over the past ten years, mounting evidence puts forth that audiovisual decision aids help (aging) patients choose wisely by explaining treatment alternatives for various life-threatening conditions like advanced dementia and cancer (El-Jawahri et al., 2010, p.
305). Films enhance communication past the typical ad hoc oral approaches to planning as regards advanced care via provision of practical and standardized descriptions of treatment alternatives. Audiovisual decision tools for planning in regard to advanced care have not been explored in the post-acute care setting whereby often, at-risk aging patients have to make serious decisions regarding treatment alternatives.
At that, my tool of choice is a series of brief videos; a condensed video that will educate the aging patient on end-of-life care and empower him/her to request for their preferred care. The nine-minute educational film will depict 3 levels of therapeutic care: life-extending care involving ventilation and cardiopulmonary resuscitation (CPR); primary care without CPR but with hospitalization; and relief care providing symptom alleviation, e.g. analgesics and oxygen. The patient will be provided with visual descriptions of each of the aforementioned categories of
care.
The video will be shown on a tablet. For example, to demonstrate life-extending care (specifically CPR), a physician in the video will be seen pushing down intensely on a dummy’s chest. The narrator (say, a surgeon) will explain the horrific odds that, in terminally-ill aging patients, CPR – most of the time – is not effective, hence the need for a ventilator for continued breathing. Then, the patient will watch a specialist maneuvering a metal device down the throat of the dummy as preparation for insertion of a duct meant to push air into the lungs. The camera will then zoom to a shot of an aging patient in a hospital bed with their eyes closed. In their mouth will be a breathing conduit, and they will be shown surrounded by machines. The surgeon will be seen saying that the patient cannot eat or speak while on the machines.
The video is meant to ensure that elderly patients are well-informed about their medical alternatives while making it easy for healthcare providers to engage in open discussions with the patients. This is so, considering that advances in medical technology can prolong life much longer than during previous years, meaning that some patients get to live longer. However, it could also mean a preference for aggressive care. Video use has been found to be effective in clinical trials; they have been found to “spark” conversations – they have been found to reverse the physician-patient relationship’s power structure. It was less likely for dying patients, as researchers found in the trials, to opt for intensive end-of-life care upon watching these videos than if they had been just informed about the procedures (Volandes et al., 2013, p. 381).
Furthermore, over the past ten years, mounting evidence puts forth that audiovisual decision aids help (aging) patients choose wisely by explaining treatment alternatives for various life-threatening conditions like advanced dementia and cancer (El-Jawahri et al., 2010, p.
305). Films enhance communication past the typical ad hoc oral approaches to planning as regards advanced care via provision of practical and standardized descriptions of treatment alternatives. Audiovisual decision tools for planning in regard to advanced care have not been explored in the post-acute care setting whereby often, at-risk aging patients have to make serious decisions regarding treatment alternatives.
At that, my tool of choice is a series of brief videos; a condensed video that will educate the aging patient on end-of-life care and empower him/her to request for their preferred care. The nine-minute educational film will depict 3 levels of therapeutic care: life-extending care involving ventilation and cardiopulmonary resuscitation (CPR); primary care without CPR but with hospitalization; and relief care providing symptom alleviation, e.g. analgesics and oxygen. The patient will be provided with visual descriptions of each of the aforementioned categories of
care.
The video will be shown on a tablet. For example, to demonstrate life-extending care (specifically CPR), a physician in the video will be seen pushing down intensely on a dummy’s chest. The narrator (say, a surgeon) will explain the horrific odds that, in terminally-ill aging patients, CPR – most of the time – is not effective, hence the need for a ventilator for continued breathing. Then, the patient will watch a specialist maneuvering a metal device down the throat of the dummy as preparation for insertion of a duct meant to push air into the lungs. The camera will then zoom to a shot of an aging patient in a hospital bed with their eyes closed. In their mouth will be a breathing conduit, and they will be shown surrounded by machines. The surgeon will be seen saying that the patient cannot eat or speak while on the machines.
The video is meant to ensure that elderly patients are well-informed about their medical alternatives while making it easy for healthcare providers to engage in open discussions with the patients. This is so, considering that advances in medical technology can prolong life much longer than during previous years, meaning that some patients get to live longer. However, it could also mean a preference for aggressive care. Video use has been found to be effective in clinical trials; they have been found to “spark” conversations – they have been found to reverse the physician-patient relationship’s power structure. It was less likely for dying patients, as researchers found in the trials, to opt for intensive end-of-life care upon watching these videos than if they had been just informed about the procedures (Volandes et al., 2013, p. 381).