Using the Emergency Department Visit to Promote Advance Care Planning
| Registry | NCT04931797, acronym VIDEO-ED |
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| Status | Completed |
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| Phase | Not applicable |
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| Study type | Interventional; randomized, parallel, masking: single, supportive care |
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| Enrollment | 598 (Actual) |
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| Sponsor | Massachusetts General Hospital (Other); collaborators: University of California, Davis, National Institute on Aging (NIA) |
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| Conditions | Emergencies |
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| Interventions | video decision aid, control arm ACP information sheet (Behavioral) |
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| Dates | start 2022-04-25, primary completion 2025-06-10, completion 2026-05-30, first posted 2021-06-18, last updated 2026-10-21 |
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| Locations | 4 sites in United States |
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Related Papers Related Patents Related Grants Related Experts
All trials for Emergencies All trials of video decision aid All trials of control arm ACP information sheet
-Summary
A randomized controlled trial of a video decision aid in the Emergency Department Setting to improve advance care planning documentation.
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+Detailed description
A randomized controlled trial of a video decision aid in the Emergency Department setting shown to patients followed by a brief advance care planning discussion and then relay that discussion to the patient's primary care provider and/or admitting clinical team and look at rates of advance care planning documentation in the electronic health record over time. Primary outcome is advance care planning documentation in the EHR at 3 months.
+Arms and interventions
| Arm | Type | Interventions | Description |
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| Video | Experimental | Behavioral: video decision aid | Video decision aid and advance care planning discussion |
| Control arm | Active comparator | Behavioral: control arm ACP information sheet | Usual advance care planning services provided at the study site. |
- video decision aid (Behavioral): advance care planning video decision aid
- control arm ACP information sheet (Behavioral): control arm ACP information sheet
+Outcome measures
Primary outcomes
- Number of Participants With EHR Documentation of Advance Care Planning at 3 Months [3 months]: EHR documentation of advance care planning at three months assessed by Natural Language Processing.
Secondary outcomes
- Patient Preferences for Goals of Care [Baseline (Day 1) for Control arm, and immediately after the video decision aid at Day 1 for the Video Arm]: Patient preference for life prolonging care, limited care or comfort care.
- Concordance Between Stated and Documented Preferences [6 months]: Concordance between stated and documented preferences among participants who died during follow-up
- ACP Documentation in the EHR [at 6 months]: Advance care planning documentation in the EHR at six months by Natural Language Processing
- Patient Knowledge of ACP [Baseline (Day 1) for Control arm, and immediately after the video decision aid at Day 1 for the Video Arm]: Knowledge score of advance care planning, range 0-5, higher value is better.
- Patient ACP Engagement With ACP Topics [Baseline (Day 1) for Control arm, and immediately after the video decision aid at Day 1 for the Video Arm]: Advance care planning engagement (ACPE) score, range 1-5, higher value is better.
+Eligibility
Sex: All, ages: 50 Years to any
Inclusion Criteria:
* anyone aged 65 and over or anyone aged over 50-64 with an indicator of serious illness
Exclusion Criteria:
* non english or spanish speakers those with a POLST legally blind medically non stable requiring ICU level care
+Posted results
Participant flow
| Milestone | Video | Control Arm |
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| Started | 298 | 300 |
| Completed | 298 | 300 |
| Not completed | 0 | 0 |
Outcome results
- Number of Participants With EHR Documentation of Advance Care Planning at 3 Months (Primary), Count of participants, Participants: Video 136; Control Arm 94 (p <0.001)
- Patient Preferences for Goals of Care (Secondary), Count of participants, Participants: Video 175; Control Arm 168 (p 0.67)
- Concordance Between Stated and Documented Preferences (Secondary), Count of participants, Participants: Video 39; Control Arm 15 (p < 0.001)
- ACP Documentation in the EHR (Secondary), Count of participants, Participants: Video 156; Control Arm 118 (p 0.002)
- Patient Knowledge of ACP (Secondary), Mean, Score on a scale: Video 4.1 +/- 1.0; Control Arm 3.1 +/- 1.1 (p <0.001)
- Patient ACP Engagement With ACP Topics (Secondary), Mean, Scores on a scale: Video 4.1 +/- 0.7; Control Arm 3.9 +/- 0.9 (p 0.004)
Adverse events
Time frame: From enrollment until end of follow-up, up to six months
| Arm | Deaths | Serious adverse events | Other adverse events |
|---|
| Video | 58/298 (19.5%) | 0/298 (0.0%) | 0/298 (0.0%) |
| Control Arm | 45/300 (15.0%) | 0/300 (0.0%) | 0/300 (0.0%) |
+Locations (4)
| Facility | City | Country | Status |
|---|
| UC Davis | Davis, California | United States | |
| Massachusetts General Hospital | Boston, Massachusetts | United States | |
| Brigham and Women's Hospital | Boston, Massachusetts | United States | |
| Newton Wellesley Hospital | Newton, Massachusetts | United States | |
+Publications
- Results publication: Volandes AE, Bohossian H, Chang Y, Lindvall C, Paasche-Orlow MK, Randa S, Samarakoon U, Hashimoto T, Shirai N, Davis AD, Goldstein NE, Garde C, Paasche-Orlow GA, Sciacca K, Klein K, Hanson E, Sage A, Nielsen DS, Walker-Corkery B, El-Jawahri A, Barry MJ, Joel M, Platts-Mills T, Durieux BN, Kwok A, Tyler KR, Ouchi K. Effect of Emergency Department-Initiated Video-Enhanced Advance Care Planning on Documentation and Goal-Concordant Care: A Randomized Clinical Trial. J Gen Intern Med. 2026 Apr 17. doi: 10.1007/s11606-026-10406-6. Online ahead of print. PMID 41998266
+Study documents
+Funding