Advance care planning (ACP) is crucial for ensuring goal-directed care, especially for individuals with advanced dementia. A recent study investigated the effectiveness of an ACP video as a Dementia Outcomes Care Plan Tool in nursing homes. This article delves into the findings of this research and its implications for improving dementia care.
The study, known as the Educational Video to Improve Nursing home Care in End-stage dementia (EVINCE) trial, was a cluster randomized clinical trial conducted across 64 nursing homes in the Boston area. It involved 402 residents with advanced dementia and their proxies, divided into intervention and control groups. The intervention group received a 12-minute ACP video designed for proxies. This video aimed to facilitate discussions and documentation of preferred levels of care (comfort, basic, or intensive), which was then communicated to the primary care team.
The primary outcome measured was the prevalence of do-not-hospitalize (DNH) directives after six months. Secondary outcomes included preferences for comfort care, documented directives to withhold tube-feeding and intravenous hydration, documented goals-of-care discussions, and the occurrence of burdensome treatments like hospital transfers, tube-feeding, or parenteral therapy.
Alt: Elderly nursing home residents receiving compassionate care from healthcare professionals.
The results indicated that while the ACP video did not significantly alter the prevalence of DNH directives or preferences for comfort care, it did have a notable impact on certain aspects of care planning. Specifically, residents in the intervention group were significantly more likely to have directives to withhold tube-feeding at 6 months and throughout the study period. Furthermore, documented goals-of-care discussions were more frequent in the intervention group at 3 months.
Interestingly, when proxies expressed a preference for comfort care, the alignment between this preference and documented advance directives was stronger in the intervention group. This suggests that the ACP video, as a dementia outcomes care plan tool, may be particularly effective in ensuring that care aligns with patient and proxy preferences in comfort-focused scenarios.
Alt: Family members and healthcare providers engaged in advance care planning discussion for dementia patient.
In conclusion, while the ACP video in this study did not broadly impact all measured outcomes such as DNH status or burdensome treatments, it did demonstrate effectiveness in increasing directives to withhold tube-feeding and in promoting goals-of-care discussions. Moreover, it improved the consistency between preferred comfort care and documented advance directives. This research highlights the potential of video-based dementia outcomes care plan tools to enhance specific aspects of advance care planning, particularly concerning tube-feeding and aligning care with comfort preferences in nursing home settings. Further research could explore how to expand the impact of such tools to encompass a broader range of end-of-life care decisions for dementia patients.
