Graphic Video Affects End of Life Decision
When Ted Goff was hospitalized late last year, barely breathing and with advanced emphysema, his doctor said the prognosis was bad. They talked about Goff’s last wishes and whether he wanted to be placed on a breathing machine. Goff wasn’t sure. So his doctor suggested he watch a video explaining this technique and other options for end-of-life care.
The video was direct and dramatic. In a demonstration of cardiopulmonary resuscitation, or CPR, a technician pushed down hard on the chest of a dummy. A white-coated doctor narrating the video laid out grim odds: “Most of the time, in patients with advanced disease, CPR does not work,” she said. As a result, patients need a ventilator to help them continue breathing. Goff watched a technician maneuver a metal instrument down the dummy’s throat to prepare for insertion of a tube that pushes air into the lungs. Then the camera zoomed to a close-up of an elderly patient, eyes closed, in a hospital bed. He had a breathing tube in his mouth. Equipment surrounded his bed.
Rare is the person who is willing to grapple openly with death. Health-care providers often don’t talk to patients about their preferences. And patients and their families often don’t know their options and avoid asking about them. For patients approaching the end of life, that can mean not knowing about palliative-care alternatives, which research has shown can significantly improve patient satisfaction and quality of life. Instead, they continue to get aggressive treatment.
Clinicians and others trying to improve end-of-life communication between doctors and their patient have turned for help to a set of videos such as the one that Goff saw. Developed by two Harvard doctors, the videos aim to better inform patients about their medical options while easing the way for frank discussions with health-care providers.
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