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Published on: May 15, 2016
A Video-Based Support Tool to Enhance Code Status Discussions in Older Adults After Trauma: A Prospective Pilot
Ashna S Karpe1, Mokunfayo O Fajemisin1,2,3, Stephanie Martinez Ugarte1,2,3
1Department of Surgery, McGovern Medical School at the University of Texas Health Science Center at Houston (UTHealth Houston), Houston, Texas, USA.
Background:
Code status discussions (CSD) are recommended for injured older adults upon admission but often do not occur. Video-based conversation aids can enhance these conversations, but data regarding their utility among older adults and surrogate decision makers after traumatic injury are limited. We hypothesized that a video-based conversation aid would be perceived as acceptable and effective in improving understanding of cardiopulmonary resuscitation (CPR) among injured older adults and their surrogates.
Methods:
A multidisciplinary focus group created a video script outlining code status and life-sustaining care for older adults and their surrogates, which was produced into a video aid. Patients and surrogates admitted to any level of care following trauma were selected by convenience sampling, viewed the video and completed the validated BRIEF health literacy assessment and a Likert scale survey to assess their perceptions of the video.
Results:
Thirty patients and 30 surrogate decision makers (N = 60) were surveyed. Median patient age was 78, and 50% (N = 15) had a high school level of education. Surrogates were younger (median age 62) and more educated (47%, N = 14 bachelor's degree, p < 0.001). A similar proportion of patients and surrogates had low levels of HL (37%, N = 11 vs. 23%, N = 7, p = 0.26). A majority of patients and surrogates felt the video improved their understanding of CPR (83%, N = 25 vs. 67%, N = 20, p = 0.31). A majority reported they easily understood the video (93%, N = 56), were not uncomfortable (68%, N = 41), and would recommend the video to others (78%, N = 47). Responses were consistent when comparing participants across HL.
Conclusions:
A video aid was found to be easily understood by a majority of injured older adults and their surrogates without increasing discomfort. Participants perceived the video as effective in increasing their knowledge of CPR and code status, but further study is required to determine its impact in routine clinical use.
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