Tuesday, May 7, 2013

How Not to Die - Revolutionizing End-of-Life Care

Angelo Volandes is exploring the role of visual media in medical decision making.  He is lending his expertise to efforts surrounding advance care planning. One of his research questions is determining whether, as part of the ACP process, patients can realistically imagine future health states which include difficult and uncomfortable hypothetical scenarios. Volandes' work was profiled in this recent, inspirational 7-page article in THE ATLANTIC.  

This sort of research (on patient decision aids) is one of the most exciting developments in bioethics and health law:  the material improvement of informed consent.  Because patients do not truly understand their prognosis and options, they choose far more aggressive interventions than they would had they been better informed.  

Angelo Volandes thinks this is "the most urgent issue facing America today, is people getting medical interventions that, if they were more informed, they would not want. It happens all the time.”  Volandes believes that his videos can disrupt the way the medical system handles late-life care, and that the system urgently needs disrupting.  I too have called attention to the problem of unwanted treatment (in this forthcoming 83-page article).  I hope that the evolving legal response can work in tandem with proven clinical improvements like those developed and tested by Volandes.

6 comments:

  1. Can you provide a link to a snippet or full video to get a flavor of the intervention?

    Thanks
    Brad

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  2. I'm glad to see that someone is addressing the issue of how thoroughly patients are made aware of their options.

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  3. They have sample videos here

    http://www.acpdecisions.org/videos/

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  4. In the context of advance care planning for advance dementia, the use of their decision aid has had dramatic effects that cut across socio-economic, racial, and cultural boundaries.

    One ethical question remains: is using video footage of a person with advanced Alzheimer's Disease emotionally coercive? Or does it appropriately and helpfully provide a more holistic understanding of the functional states associated with the disease?

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  5. Volandes is careful to avoid bias to the extent possible. While he depicts severe dementia, he uses subjects that look really nice (better than they would in real life).

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    ReplyDelete