What if every person with advanced illness could see a video of what their future would look like? Say, a video of CPR being administered and its aftermath of a breathing tube forcing air down a patient’s throat? Or an honest movie picturing what advanced dementia looks like?
If patients and families could see such a video, would it make a difference in the medical treatments they might choose or refuse as the disease progresses?
These questions are being answered and these videos are available right now.
Last week, NPR radio talk show host Diane Rehm hosted a program “Making Better End-of-Life Care Decisions.” Two of her guests were Drs. Angelo Volandes and Aretha Delight Davis, both of the Harvard Medical School. They have a mission of producing realistic videos of what advanced illness looks like and actual footage of treatments like feeding tubes and ventilators.
The bottom line on the research is that when patients and/or their families see videos of actual treatments, they are more likely to refuse the treatment than if a physician just explains what the treatment is like. It is the old a-picture-is-worth-a-thousand-words adage.
The Atlantic ran a great article on the whole video project, “How Not to Die” by Jonathan Rauch.
One of the things I like about what I see is the depiction of the aftermath of some life-prolonging treatments. Take CPR, for example. Successful resuscitation attempts are rare. “Successful” being defined as “the patient did not die.” At best, the procedure is successful only about 15% of the time. What is hidden in the “successful” statistic is that half of those survivors have brain damage following the interruption of the blood flow to the brain. AND, what you see in the video, the patient is highly likely to be hooked up to a ventilator (breathing machine) after being resuscitated.
So the combination low survival rates, the likelihood of brain damage, and increased chance of being tethered to a machine cause many people to pause before telling the medical team to “do everything.” We now have videos to show what all the words have been trying to convey. What a great contribution of Drs. Volandes and Davis!