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: Volume 13, Issue 2, p. 51–61, June 2017

Posted: 19 Jun 2017

See all articles by Ferdinando Mirarchi

Ferdinando Mirarchi

University of Pittsburgh - Medical Center (UPMC)

Timothy Cooney

Independent

Arvind Venkat

Allegheny Health Network - Allegheny General Hospital; Allegheny Health Network - Department of Emergency Medicine; Drexel University - College of Medicine

David Wang

Stanford University

Thaddeus Mason Pope

Mitchell Hamline School of Law; Queensland University of Technology - Australian Health Law Research Center; Alden March Bioethics Institute; Saint Georges University

Stanley Terman

Caring Advocates or Institute for Strategic Change

Kevin Klauer

Independent

Brian Clemency

Independent

Michael Gisondi

Northwestern University

Stephanie Harman

Stanford University

Ankur Doshi

University of Pittsburgh - School of Medicine; University of Pittsburgh - Medical Center (UPMC)

Mari Siegel

Temple University

Mary Kraemer

Temple University

Kate Aberger

Independent

Jestin Carlson

Independent

Kristopher Hart

Independent

Jason Wilson

Independent

Bradley Gordon

Independent

Date Written: June 16, 2017

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.

Keywords: POLST, Advance Directive, Living Will, Video

JEL Classification: K13, K32

Suggested Citation

Mirarchi, Ferdinando and Cooney, Timothy and Venkat, Arvind and Wang, David and Pope, Thaddeus Mason and Terman, Stanley and Klauer, Kevin and Clemency, Brian and Gisondi, Michael and Harman, Stephanie and Doshi, Ankur and Siegel, Mari and Kraemer, Mary and Aberger, Kate and Carlson, Jestin and Hart, Kristopher and Wilson, Jason and Gordon, Bradley, TRIAD VIII: Nationwide Multicenter Evaluation to Determine Whether Patient Video Testimonials Can Safely Help Ensure Appropriate Critical versus End-of-Life Care (June 16, 2017). Journal of Patient Safety: Volume 13, Issue 2, p. 51–61, June 2017, Available at SSRN: https://ssrn.com/abstract=2988140

Ferdinando Mirarchi

University of Pittsburgh - Medical Center (UPMC) ( email )

Pittsburgh, PA
United States

Timothy Cooney

Independent ( email )

Arvind Venkat

Allegheny Health Network - Allegheny General Hospital ( email )

320 East North Avenue
Pittsburgh, PA 15212
United States

Allegheny Health Network - Department of Emergency Medicine ( email )

Allegheny General Hospital, Level 01 320 East N
Pittsburgh, PA 15212
United States

Drexel University - College of Medicine ( email )

David Wang

Stanford University ( email )

Stanford, CA 94305
United States

Thaddeus Mason Pope (Contact Author)

Mitchell Hamline School of Law ( email )

875 Summit Avenue
Room 320
Saint Paul, MN 55105
United States
651-695-7661 (Phone)

HOME PAGE: http://www.thaddeuspope.com

Queensland University of Technology - Australian Health Law Research Center ( email )

2 George Street
Brisbane, Queensland 4000
Australia

Alden March Bioethics Institute ( email )

47 New Scotland Ave
MC 153
Albany, NY 12208
United States

HOME PAGE: http://www.thaddeuspope.com

Saint Georges University ( email )

West Indies
Grenada

HOME PAGE: http://www.thaddeuspope.com

Stanley Terman

Caring Advocates or Institute for Strategic Change ( email )

45 Bulkley Avenue
#4
Sausalito, CA 94965
United States
(760) 704-7524 (Phone)
(888) 767-6322 (Fax)

HOME PAGE: http://www.CaringAdvocates.org

Kevin Klauer

Independent ( email )

Brian Clemency

Independent ( email )

Michael Gisondi

Northwestern University ( email )

2001 Sheridan Road
Evanston, IL 60208
United States

Stephanie Harman

Stanford University ( email )

Stanford, CA 94305
United States

Ankur Doshi

University of Pittsburgh - School of Medicine ( email )

University of Pittsburgh - Medical Center (UPMC) ( email )

Pittsburgh, PA
United States

Mari Siegel

Temple University ( email )

Philadelphia, PA 19122
United States

Mary Kraemer

Temple University ( email )

Philadelphia, PA 19122
United States

Kate Aberger

Independent ( email )

Jestin Carlson

Independent ( email )

Kristopher Hart

Independent ( email )

Jason Wilson

Independent ( email )

Bradley Gordon

Independent ( email )

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