After viewing the video, study participants are asked about their reactions.
“What we universally hear is, ‘I am a visual learner,’ ” Volandes said. “ ‘I heard the words you said, CPR and comfort care, but I had no idea that’s what you were talking about.’ ”
Volandes has been using his videos in his own practice, and he said discussions with several Massachusetts health-care systems could lead to wider use. They are already used in about 35 health-care systems in other states, he said.
The Massachusetts health-care cost containment law approved last summer requires the health commissioner to adopt regulations ordering each licensed hospital, nursing home, health center, or assisted-living facility to distribute to “appropriate patients” information regarding the availability of palliative care — care that prevents or relieves pain and suffering and enhances quality of life, including hospice care — and end-of-life options.
It does not define appropriate patients, nor does it say how the information should be distributed.
Andy Epstein, special assistant to the state health commissioner, said officials this month started discussions with end-of-life specialists to plan this initiative.
With limited money, the Patrick administration has employed a low-budget, grassroots approach, such as visiting senior centers to hold “kitchen table”-style talks about end-of-life care options.
“When we go to senior centers and talk to the seniors they say, ‘My kids don’t want to talk about this, they don’t want to upset me,’ ” said Ruth Palombo, assistant secretary of the state Executive Office of Elder Affairs. “Then when we talk to the kids they say, ‘My parents don’t want to talk about it.’ These conversations are hard to have.”
One of the panel’s recommendations is gaining traction. A state education campaign about MOLST — Medical Orders for Life-Sustaining Treatment — has been slowly introduced in roughly 169 hospitals, nursing homes, and home-care agencies, Epstein said.
The $400,000 annual campaign trains medical staff on initiating end-of-life conversations with patients to help them complete a two-page legal document that details specific treatments each patient would want or decline if acutely ill, such as CPR, or being connected to machines that pump air into their lungs or feed them through tubes.
The MOLST forms are more detailed than Do Not Resusciate orders patients more routinely encounter, which simply state whether patients want CPR if their heart stops.
Steward Health Care, a community-based network that includes 11 hospitals in Eastern Massachusetts, aims to use MOLST forms by April 16, said Dr. Marcy Carty, who is leading the initiative.
She said the year-long preparations to launch the project included an analysis of how Steward’s facilities would mesh each patient’s paper MOLST form with the system’s increasingly electronic medical records. Amid a nationwide push to convert paper health records to electronic files, some states, including Massachusetts, are choosing to keep MOLST forms on paper, so that they stay with each patient.
“We want to make sure we discover what our patients’ preferences are, that we document them, and that we meet those preferences,” Carty said.
Kay Lazar can be reached at firstname.lastname@example.org.