Here is the standardised PICO analysis for the thirty-ninth uploaded article:
Full Title
Effect of a Video-assisted Advance Care Planning Intervention on End-of-Life Health Care Transitions among Long-Stay Nursing Home Residents
Authors: Patience Moyo, Lacey Loomer, Joan Teno, et al.
Journal: Journal of the American Medical Directors Association, 2022; 23(3):394–398
DOI: 10.1016/j.jamda.2021.09.014
Type of Study
Post hoc analysis of a pragmatic cluster randomised controlled trial (PROVEN trial)
PICO Summary
Population (P)
- Long-stay nursing home residents (≥65 years) with advanced dementia or cardiopulmonary disease (COPD or CHF)
- Residents from 360 nursing homes (119 intervention, 241 control) across 32 U.S. states
- All decedents included had ≥90 days of observation prior to death
- Final sample: 923 (intervention) and 1,925 (control) decedents with advanced illness
Intervention (I)
- Video-assisted advance care planning (ACP) intervention as part of the PROVEN trial
- Up to 5 brief ACP videos (6–10 mins) in English or Spanish
- Topics: general goals of care, goals in advanced dementia, hospice, hospitalization, healthy ACP
- Delivered by trained “video champions” (usually social workers) under guidance to offer videos:
- At admission/readmission
- Every 6 months
- After clinical change or major decision
- With visiting family
- Only 24.4% of those offered a video actually watched it
Comparison (C)
- Usual care: routine advance care planning practices without structured video intervention
Outcomes (O)
Primary outcome:
- Hospital transfer in the last 90 days of life
- Intervention group: 3.8%
- Control group: 5.7%
- Absolute risk difference: –1.7% (95% CI: –3.2% to –0.1%)
Secondary outcomes:
- ≥3 hospital transfers in last 90 days: –0.8% (NS)
- Late transitions (hospitalisation in final 3 days or hospice admission on final day): –2.2% (NS)
- ICU admission: 14.7% vs 18.2%, p = 0.02
- No differences in tube feeding, ventilation, or parenteral therapy rates
- Hospice enrolment: 30.7% (intervention) vs 31.0% (control)
Findings Summary
This large-scale trial found that a video-assisted ACP intervention was modestly effective in reducing hospital transfers in the last 90 days of life, but not late transitions or repeated hospitalisations. ICU admissions were also significantly reduced, suggesting some benefits for end-of-life care intensity.
Key limitations:
- Low fidelity: Only 24% of those offered the video actually viewed it
- Implementation challenges in real-world settings
- Findings may underrepresent the full potential impact of ACP if more widely adopted
This study underscores that while video interventions can support care alignment near end-of-life, organisational uptake and consistent delivery remain significant challenges in nursing homes.
Life In The Slower Lane 
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