A Multimedia Intervention on Cardiopulmonary Resuscitation and Advance Directives

Overview

Journal J Gen Intern Med

Publisher Springer

Specialty General Medicine

Date 1999 Sep 22

PMID 10491246

Citations 8

Authors

R Yamada

A T Galecki

S D Goold

R V Hogikyan

Affiliations

Soon will be listed here.

Abstract

Objective: To assess the effects of a multimedia educational intervention about advance directives (ADs) and cardiopulmonary resuscitation (CPR) on the knowledge, attitude and activity toward ADs and life-sustaining treatments of elderly veterans.

Design: Prospective randomized controlled, single blind study of educational interventions.

Setting: General medicine clinic of a university-affiliated Veterans Affairs Medical Center (VAMC).

Participants: One hundred seventeen Veterans, 70 years of age or older, deemed able to make medical care decisions.

Intervention: The control group (n = 55) received a handout about ADs in use at the VAMC. The experimental group (n = 62) received the same handout, with an additional handout describing procedural aspects and outcomes of CPR, and they watched a videotape about ADs.

Measurements And Main Results: Patients' attitudes and actions toward ADs, CPR and life-sustaining treatments were recorded before the intervention, after it, and 2 to 4 weeks after the intervention through self-administered questionnaires. Only 27.8% of subjects stated that they knew what an AD is in the preintervention questionnaire. This proportion improved in both the experimental and control (87.2% experimental, 52.5% control) subject groups, but stated knowledge of what an AD is was higher in the experimental group (odds ratio = 6.18, p <.001) and this effect, although diminished, persisted in the follow-up questionnaire (OR = 3.92, p =. 003). Prior to any intervention, 15% of subjects correctly estimated the likelihood of survival after CPR. This improved after the intervention in the experimental group (OR = 4.27, p =.004), but did not persist at follow-up. In the postintervention questionnaire, few subjects in either group stated that they discussed CPR or ADs with their physician on that day (OR = 0.97, p = NS).

Conclusion: We developed a convenient means of educating elderly male patients regarding CPR and advance directives that improved short-term knowledge but did not stimulate advance care planning.

Citing Articles

Increasing the completion rate of the advance directives in primary care setting - a randomized controlled trial.

Xu C, Yan S, Chee J, Lee E, Lim H, Lim S BMC Fam Pract. 2021; 22(1):115.

PMID: 34144695 PMC: 8214280. DOI: 10.1186/s12875-021-01473-1.

Association of Communication Interventions to Discuss Code Status With Patient Decisions for Do-Not-Resuscitate Orders: A Systematic Review and Meta-analysis.

Becker C, Lecheler L, Hochstrasser S, Metzger K, Widmer M, Thommen E JAMA Netw Open. 2019; 2(6):e195033.

PMID: 31173119 PMC: 6563579. DOI: 10.1001/jamanetworkopen.2019.5033.

Communication Tools for End-of-Life Decision-Making in Ambulatory Care Settings: A Systematic Review and Meta-Analysis.

Oczkowski S, Chung H, Hanvey L, Mbuagbaw L, You J PLoS One. 2016; 11(4):e0150671.

PMID: 27119571 PMC: 4847908. DOI: 10.1371/journal.pone.0150671.

Death in the Digital Age: A Systematic Review of Information and Communication Technologies in End-of-Life Care.

Ostherr K, Killoran P, Shegog R, Bruera E J Palliat Med. 2015; 19(4):408-20.

PMID: 26713368 PMC: 4827321. DOI: 10.1089/jpm.2015.0341.

Video decision aids to assist with advance care planning: a systematic review and meta-analysis.

Jain A, Corriveau S, Quinn K, Gardhouse A, Vegas D, You J BMJ Open. 2015; 5(6):e007491.

PMID: 26109115 PMC: 4480030. DOI: 10.1136/bmjopen-2014-007491.

References

Malloy T, Wigton R, Meeske J, Tape T . The influence of treatment descriptions on advance medical directive decisions. J Am Geriatr Soc. 1992; 40(12):1255-60. DOI: 10.1111/j.1532-5415.1992.tb03652.x. View

Niemann J . Cardiopulmonary resuscitation. N Engl J Med. 1992; 327(15):1075-80. DOI: 10.1056/NEJM199210083271507. View

Finucane T . Attempted cardiopulmonary resuscitation in nursing homes. Am J Med. 1993; 95(2):121-2. DOI: 10.1016/0002-9343(93)90251-j. View

Elpern E, Yellen S, Burton L . A preliminary investigation of opinions and behaviors regarding advance directives for medical care. Am J Crit Care. 1993; 2(2):161-7. View

Bonnin M, Pepe P, Clark Jr P . Survival in the elderly after out-of-hospital cardiac arrest. Crit Care Med. 1993; 21(11):1645-51. DOI: 10.1097/00003246-199311000-00012. View

Murphy D, Burrows D, Santilli S, Kemp A, Tenner S, Kreling B . The influence of the probability of survival on patients' preferences regarding cardiopulmonary resuscitation. N Engl J Med. 1994; 330(8):545-9. DOI: 10.1056/NEJM199402243300807. View

Gates R, Weaver M, Gates R . Patient acceptance of an information sheet about cardiopulmonary resuscitation options. J Gen Intern Med. 1993; 8(12):679-82. DOI: 10.1007/BF02598286. View

Nease Jr R, Brooks W . Patient desire for information and decision making in health care decisions: the Autonomy Preference Index and the Health Opinion Survey. J Gen Intern Med. 1995; 10(11):593-600. DOI: 10.1007/BF02602742. View

Tulsky J, Chesney M, Lo B . See one, do one, teach one? House staff experience discussing do-not-resuscitate orders. Arch Intern Med. 1996; 156(12):1285-9. DOI: 10.1001/archinte.156.12.1285. View

10.

Eisenberg M, Hallstrom A, Bergner L . Long-term survival after out-of-hospital cardiac arrest. N Engl J Med. 1982; 306(22):1340-3. DOI: 10.1056/NEJM198206033062206. View

11.

Gulati R, Bhan G, Horan M . Cardiopulmonary resuscitation of old people. Lancet. 1983; 2(8344):267-9. DOI: 10.1016/s0140-6736(83)90244-1. View

12.

Tresch D, Thakur R, Hoffmann R, Brooks H . Comparison of outcome of resuscitation of out-of-hospital cardiac arrest in persons younger and older than 70 years of age. Am J Cardiol. 1988; 61(13):1120-2. DOI: 10.1016/0002-9149(88)90141-5. View

13.

Murphy D, Murray A, Robinson B, Campion E . Outcomes of cardiopulmonary resuscitation in the elderly. Ann Intern Med. 1989; 111(3):199-205. DOI: 10.7326/0003-4819-111-3-199. View

14.

Davidson K, Hackler C, Caradine D, McCord R . Physicians' attitudes on advance directives. JAMA. 1989; 262(17):2415-9. View

15.

Longstreth Jr W, Cobb L, Fahrenbruch C, Copass M . Does age affect outcomes of out-of-hospital cardiopulmonary resuscitation?. JAMA. 1990; 264(16):2109-10. View

16.

Schonwetter R, Teasdale T, Taffet G, Robinson B, LUCHI R . Educating the elderly: cardiopulmonary resuscitation decisions before and after intervention. J Am Geriatr Soc. 1991; 39(4):372-7. DOI: 10.1111/j.1532-5415.1991.tb02902.x. View

17.

Annas G . The health care proxy and the living will. N Engl J Med. 1991; 324(17):1210-3. DOI: 10.1056/NEJM199104253241711. View

18.

Greco P, Schulman K, Lavizzo-Mourey R . The Patient Self-Determination Act and the future of advance directives. Ann Intern Med. 1991; 115(8):639-43. DOI: 10.7326/0003-4819-115-8-639. View

19.

Miller D, Jahnigen D, Gorbien M, Simbartl L . Cardiopulmonary resuscitation: how useful? Attitudes and knowledge of an elderly population. Arch Intern Med. 1992; 152(3):578-82. DOI: 10.1001/archinte.152.3.578. View

20.

Schonwetter R, Walker R, Kramer D, Robinson B . Resuscitation decision making in the elderly: the value of outcome data. J Gen Intern Med. 1993; 8(6):295-300. DOI: 10.1007/BF02600139. View