Preventing Overmedicalization During End-Of-Life Care
The Atlantic published an article in May 2013 by Jonathan Rauch entitled “How Not to Die,” which discussed the problem of over overmedicalization and proposed a solution using educational videos.
According to the article, patients routinely receive unwanted care, especially when the patient is nearing his or her end of life. The physicians administering these unwanted treatments are not necessarily motivated by any malevolent intent, but are simply determined to save lives, whereas the patient, if fully informed, often focuses on the quality of his or her remaining time. When physicians recommend treatment based on “highly inaccurate” assumptions of the patients’ goals, the result is unwanted treatment that many say is tantamount to abuse or even torture.
Medical professionals are supposed to hold “The Conversation” with their patients, which would include a meaningful explanation of the patient’s condition and treatment options, as well as a discussion about the patient’s goals and desired treatment. Evidence indicates, however, that The Conversation happens infrequently, and, when it does take place, is often rushed and loaded with medical jargon, which the patients and families fail to fully comprehend. Instead, Dr. Angelo Volandes found he could make a stronger, cleaner impression on his patients by showing them treatments, rather than simply trying to describe them.
With this in mind, Dr. Volandes began creating Advanced Care Planning Decisions videos. There are videos on a range of topics, from CPR to advanced stage dementia, and each video is intended to educate and empower patients about their choices for medical care. Each film is on average six minutes long, and is meant to be screened on iPads or laptops while in a clinic or hospital room. The impact is apparent: In a 2009 study, more than 90% of patients chose comfort care after watching a video on cancer treatment, whereas only 22% did so after receiving only a verbal description of such treatment.
The videos are meant to provide clearer information and, more importantly, trigger The Conversation between the patient and medical professional.
These videos are inexpensive and low-tech, and might avert misunderstanding, prevent suffering, improve doctor-patient relationships, and incidentally, save the health-care system a lot of money. Only a few dozen out of 5,700 hospitals are presently using the videos, though Dr. Volandes hopes their use becomes more prevalent, which he believes will revolutionize end-of-life care.