Effect of a Video-Assisted Advance Care Planning Intervention on End-of-Life Health Care Transitions Among Long-Stay Nursing Home Residents.
Patience Moyo, Lacey Loomer, Joan M Teno and 6 others
PMID 34627753WHAT IT FOUND
Video advance care planning did not reduce multiple transfers or late transitions in long-stay nursing home residents with advanced illness who died, and only 24.4% of offered intervention residents were shown a video.
Fewer residents had any hospital transfer in the last 90 days.
Key findings
01Any hospital transfer in the last 90 days of life occurred in 3.8% of intervention decedents and 5.7% of control decedents, with an adjusted marginal difference of −1.7% (95% CI −3.2% to −0.1%).
02Multiple hospital transfers, hospital transfer in the last 3 days, and hospice transfer in the last day of life did not significantly differ between arms.
03Only 24.4% of decedents in the intervention group were shown an ACP video among those offered the opportunity to watch one.
STILL TO COME
How it was doneWhat they foundWhat it means for RNs
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What it does not show
This was a post hoc analysis of residents who died, not a prespecified primary or secondary outcome, so it may be underpowered. Intervention delivery was low: only 24.4% of decedents in the intervention group were shown a video among those offered. Resident or family preferences and advance directives were not available because they were not collected in the MDS or systematically documented in electronic health records. Hospital transfer rates were falling nationally during the trial period, although both arms were affected. The analysis includes only decedents, so it does not describe effects among residents who did not die.
Declared interests
The article is listed as supported by NIH extramural research. Dr. Loomer reported contract work for the American Health Care Association. Dr. Volandes has a financial interest in ACP Decisions, a nonprofit organization developing advance care planning video decision support tools; his interests were reviewed and managed by MGH and Mass General Brigham. Dr. Mor chairs the Scientific Advisory Board of naviHealth and is compensated for that role. No other disclosures were reported.
The easy way to misread this
Do not read the lower 90-day hospital transfer rate as proof that video advance care planning works. This was a post hoc decedent subgroup, other transition outcomes were not significant, and only 24.4% of offered residents were shown a video.