A multimedia intervention on cardiopulmonary resuscitation and advance directives

OBJECTIVE: To assess the effects of a multimedia educational intervention a bout advance directives (ADs) and cardiopulmonary resuscitation (CPR) on th e knowledge, attitude and activity toward ADs and life-sustaining treatment s of elderly veterans. DESIGN: Prospective randomized controlled, single blind study of educationa l interventions. SETTING: General medicine clinic of a university-affiliate Veterans Affairs Medical Center (VAMC). PARTICIPANTS: One hundred seventeen Veterans, 70 years of age or older, dee med able to make medical care decisions. INTERVENTION: The control group (n = 55) received a handout about ADs in us e at the VAMC. The experimental group (n = 62) received the same handout, w ith an additional handout describing procedural aspects and outcomes of CPR , and they watched a videotape about ADs. MEASUREMENTS AND MAIN RESULTS: Patients' attitudes and actions toward ADs, CPR and life-sustaining treatments were recorded before the intervention, a fter it, and 2 to 4 weeks after the intervention through self-administered questionnaires. Only 27.8% of subjects stated that they knew what an AD is in the preintervention questionnaire. This proportion improved in both the experimental and control (87.2% experimental, 52.5% control) subject groups , but stated knowledge of what an AD is was higher in the experimental grou p (odds ratio = 6.18, p < .001) and this effect, although diminished, persi sted in the follow-up questionnaire (OR = 3.92, p = .003). Prior to any int ervention, 15% of subjects correctly estimated the likelihood of survival a fter CPR. This improved after the intervention in the experimental group (O R = 4.27, p = .004), but did not persist at follow-up. In the postintervent ion questionnaire, few subjects in either group stated that they discussed CPR or ADs with their physician on that day (OR = 0.97, p = NS). CONCLUSION: We developed a convenient means of educating elderly male patie nts regarding CPR and advance directives that improved short-term knowledge but did not stimulate advance care planning.