Testing a Video Decision Support Tool to Supplement Goals-of-Care Discussions

• The difference in proportions of patient subjects/proxies in each group (observation vs video phase) who prefer comfort oriented care and who die in accordance with their stated preferences. [ Time Frame: Measured on average within 48 hours of the palliative care service's referral of the subject to the research team, as well as 7-14 days, 2-3 months and 5-6 months post-discharge. ] [ Designated as safety issue: No ]
  

• The level of uncertainty regarding treatment preferences. [ Time Frame: Measured on average within 48 hours of the palliative care service's referral of the subject to the research team. ] [ Designated as safety issue: No ]
  
• Satisfaction with pain control and symptom management. [ Time Frame: Measured on average within 48 hours of the palliative care service's referral of the subject to the research team, as well as 7-14 days, 2-3 months and 5-6 months post-discharge. ] [ Designated as safety issue: No ]
  
• Healthcare proxy satisfaction with end-of-life care following subjects' death. [ Time Frame: Measured at 7-14 days, 2-3 months or 5-6 months post-discharge. ] [ Designated as safety issue: No ]
  
• Concordance between patient subjects' and staffs' ranking of symptoms. [ Time Frame: Measured on average within 48 hours of the palliative care service's referral of the subject to the research team. ] [ Designated as safety issue: No ]
  

The investigators research will be conducted as a non-randomized, temporal intervention study. The specific aim of the study is to assess the effect of a video decision support tool on preferences for end-of-life care in patients and surrogate decision makers consulted on by an inpatient palliative care service. The first seven months of the study, or until 25 patient subjects are recruited, will be the observational phase. All participants recruited will receive the usual standard of care provided by an inpatient palliative care service. Using a battery of surveys, data will be collected regarding treatment preferences near the end of life, level of certainty with decision making, pain and symptom management, resource utilization and whether patient subjects die in accordance with their stated preferences. Once the observational phase is complete, the intervention phase of the study will begin. Over the following seven months, or until 25 patient subjects are recruited, all participants will view a six-minute digital video outlining different options for care near the end of life. The same endpoints will then be followed. In addition to the primary analysis involving patient-proxy dyads, an additional exploratory analysis will be performed. This analysis will involve surveying additional medical staff including attendings, residents, interns and nurses regarding their perceptions of patients' symptoms at the time of the palliative care consult. This data will be used to measure concordance between patient subjects' and staffs' ranking of symptoms.