A randomized controlled trial of a CPR and intubation video decision support tool for hospitalized patients
Open accessAbstract
Background Decisions about cardiopulmonary resuscitation (CPR) and intubation are a core part of advance care planning, particularly for seriously ill hospitalized patients. However, these discussions are often avoided. Objectives We aimed to examine the impact of a video decision tool for CPR and intubation on patients' choices, knowledge, medical orders, and discussions with providers. Design This was a prospective randomized trial conducted between 9 March 2011 and 1 June 2013 on the internal medicine services at two hospitals in Boston. Participants One hundred and fifty seriously ill hospitalized patients over the age of 60 with an advanced illness and a prognosis of 1 year or less were included. Mean age was 76 and 51% were women. Intervention Three-minute video describing CPR and intubation plus verbal communication of participants' preferences to their physicians (intervention) (N = 75) or control arm (usual care) (N = 75). Main measures The primary outcome was participants' preferences for CPR and intubation (immediately after viewing the video in the intervention arm). Secondary outcomes included: orders to withhold CPR/intubation, documented discussions with providers during hospitalization, and participants' knowledge of CPR/ intubation (five-item test, range 0-5, higher scores indicate greater knowledge). Results Intervention participants (vs. controls) were more likely not to want CPR (64% vs. 32%, p <0.0001) and intubation (72% vs. 43%, p < 0.0001). Intervention participants (vs. controls) were also more likely to have orders to withhold CPR (57% vs. 19%, p < 0.0001) and intubation (64% vs.19%, p < 0.0001) by hospital discharge, documented discussions about their preferences (81% vs. 43%, p < 0.0001), and higher mean knowledge scores (4.11 vs. 2.45; p < 0.0001). Conclusions Seriously ill patients who viewed a video about CPR and intubation were more likely not to want these treatments, be better informed about their options, have orders to forgo CPR/ intubation, and discuss preferences with providers. Trial registration Clinicaltrials.gov NCT01325519 Registry Name: A prospective randomized trial using video images in advance care planning in seriously ill hospitalized patients.
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Where an awareness video was used, people said they did not want intubation.
“where an awareness video was used people said they did not want intubation.59”
From Do not attempt cardiopulmonary resuscitation decision-making process: scoping review (2025) · cites this paper as [59]
In recent guidelines, patient/family satisfaction was considered as a core outcome.
“In recent guidelines, patient/family satisfaction was considered as a core outcome. 26”
From European Resuscitation Council Guidelines 2021: Ethics of resuscitation and end of life decisions (2021) · cites this paper as [26]
The Secondary Outcomes and Data Collection and Outcomes sections discuss patients’ comfort with the video and whether they would recommend it, not patient or family satisfaction as a core outcome. Searches for guidelines, satisfaction, and core outcomes found no passage in our copy addressing what recent guidelines recommend. (LLM, conf=0.76)
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“understanding of the purpose of CPR and resuscitation options.(4,17,272) Educational CPR videos and structured patient-centred interviews can be helpful in decision making with more patients likely to forgo CPR and focus on comfort.”
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“29 El-Jawahri et al 59 recommended a video decision support tool.”
- Authors
- El-Jawahri, A., Mitchell, S. L., Paasche-Orlow, M. K., Temel, J. S., Jackson, V. A., Rutledge, R. R., Parikh, M., Davis, A. D., Gillick, M. R., Barry, M. J., Lopez, L., Walker-Corkery, E. S., Chang, Y., Finn, K., Coley, C., & Volandes, A. E.
- Affiliations
- Massachusetts General Hospital (US)
- Harvard University (US)
- Oregon Health & Science University (US)
- University of California, San Francisco (US)
- Mount Auburn Hospital (US)
- Corresponding author
- El-Jawahri, Areej
- ORCID
- Venue
- Journal of General Internal Medicine
- Published
- 2015-02-18
- Volume
- 30
- Issue
- 8
- Pages
- 1071-1080
- ISSN
- 0884-8734 (ISSN-L)
- 1525-1497
- PMC
- PMC4510229
- OpenAlex
- W2030098570
- Cited by
- 95
- References
- 1
- Citations by year
- 2026: 6 · 2025: 7 · 2024: 5 · 2023: 7 · 2022: 8 · 2021: 9 · 2020: 9 · 2019: 10 · 2018: 10 · 2017: 14 · 2016: 6 · 2015: 4
- FWCI
- 12.15
- Type
- journal article
- Language
- en
- Open access
- bronze
- doi.org
- Licence
- www.springer.com/tdm (tdm)
- Locations
- Journal of General Internal Medicine (publishedVersion)
- Europe PMC (PubMed Central) (publishedVersion)
- PubMed Central (publishedVersion)
- PubMed (publishedVersion)
- Funders
- Informed Medical Decisions Foundation
- Agency for Healthcare Research and Quality (K08HS018780)
- National Institute on Aging (K24AG033640)
- Topics
- Health Sciences › Medicine › Public Health, Environmental and Occupational Health › Palliative Care and End-of-Life Issues
- Health Sciences › Medicine › Emergency Medicine › Cardiac Arrest and Resuscitation
- Health Sciences › Medicine › Public Health, Environmental and Occupational Health › Ethics and bioethics in healthcare
- Keywords
- cardiopulmonary resuscitation, intubation, advance care planning, end-of-life decisions, older adults, withholding life-sustaining treatment, patient-provider communication, advance directives, medical inpatients
- MeSH terms
- Aged, Aged, 80 and over, Decision Making, Female, Humans, Inpatients, Intubation, Intratracheal, Male, Middle Aged, Prospective Studies, Videotape Recording, Resuscitation Orders, Critical Illness, Cardiopulmonary Resuscitation, Decision Support Systems, Clinical, Patient Preference
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