Home Patient Safety Helping patients get the picture

Helping patients get the picture

August 2013

Published in the August 2013 issue of Today’s Hospitalist

ANGELO VOLANDES, MD, MPH, continues to film portions of all of his patient education videos in his living room, using his wife “Aretha Davis, MD “as narrator. But don’t let that fact make you think that anything about his Advanced Care Planning Decisions video series is “home grown.”

Dr. Volandes has developed the script for each of the 30 videos in collaboration with national experts. Many videos become the subject of randomized controlled trials funded by the NIH to gauge their impact on patient decision-making, with results published in journals including the British Medical Journal.

The series is now licensed by 50 hospitals and health care systems around the country, including giants like Kaiser Permanente. And in Hawaii, the state’s Blue Cross Blue Shield is making the videos available to 1.3 million patients.

“Our expectation,” says Dr. Volandes, an assistant professor at Harvard Medical School who works several months a year as a teaching attending on the hospitalist service at Massachusetts General Hospital, “is that in five years, watching these videos with your clinician will be the standard of care throughout the country.”

Dr. Volandes started the videos and the nonprofit foundation that distributes them in 2004. Most videos are three to five minutes long.
The video series began by tackling end-of-life care issues, but has since expanded into other areas of advanced disease. Each video is designed to be watched with a clinician to supplement a discussion of end-of-life or treatment goals.

Doctors who admit a patient with metastatic cancer for shortness of breath, for instance, can take a history and physical and discuss code status, then introduce the video on CPR on their iPad.

“In 15 years of giving patients advance directive packages, not a single one has ever opened them,” says Dr. Volandes. “Patients prefer to view videos rather than read pamphlets written at a college level filled with medical jargon.”

The advantage of watching the videos with patients, he explains, is to standardize conversations and get patients engaged. The goal of the video on CPR, for instance, is to help patients understand different care options so they can make informed choices.

“The videos never mention costs or ‘resource utilization,'” says Dr. Volandes, who gives as many as 75 talks a year and plans to have 300 videos in the series within five years. “If patients watching them end up wanting everything available in the hospital, that’s fine.”

But he adds that most patients who watch, particularly those with life-limiting conditions, end up not wanting everything. “It’s not that it’s futile or costly care,” he says. “It’s unwanted.”