Video Declarations from Patients with Advanced Cancer: A Tool to Assist with Goals of Care Conversations

Goals of care discussions depend upon a clear articulation of a patient's values. Yet, many patients struggle to communicate what matters most to them, or they are not given the opportunity to discuss the goals they have for their medical care. Video declarations (ViDecs) of care preferences may complement traditional advance directive forms by exploring patient priorities and facilitating future patient-provider advance care planning (ACP) discussions.

To evaluate the content of patients' Video declarations (ViDecs) and describe how ViDecs may elucidate ACP preferences and decision-making factors.

We recorded video and audio declarations of goals of care preferences from a sub-sample of participants in a mixed-methods pragmatic stepped-wedge cluster randomized trial.

Patients over 65 years old with advanced cancer from 36 oncology clinics among three unique healthcare systems.

Qualitative Thematic Content Analysis.

We reviewed ViDecs from 112 participants with a mean age of 72 years (SD = 5 years), 65% were female, 68% self-reported as White. In this analysis, we focus on how goals of care preferences were expressed in ViDecs and the specific factors that participants described as motivating their decision-making. Participant perceptions of prognosis appeared to influence a "give it a try" perspective. Participants also sought to maximize beneficial medical care and discussed how experiential factors, such as witnessing the dying process of another person, impacted their decision-making. ViDecs often did not convey clear preferences around medical interventions.

We found that patients' ViDecs emphasized decision-making factors critical to the ACP discussion process rather than specific decisions around medical interventions that may be pursued in an uncertain future. ViDecs may be a patient-centered tool that patients, families, and clinicians can use to better prepare patients and caregivers to make future health care decisions that are more consistent with their values and priorities.