1 2 3 4 Traditionally, physicians help patients to engage in

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Among the 94/106 (89%) participants re interviewed in the verbal group, 27 (29%) changed their preferences (=0.35). Among the 84/94 (89%) participants re interviewed in the video group, five (6%) changed their preferences (=0.79) (PConclusion Older people who view a video depiction of a patient with advanced dementia after hearing a verbal description of the condition are more likely to opt for comfort as their goal of care compared with those who solely listen to a verbal description. They also have more stable preferences over time.Respecting patients’ preferences for treatment is a key component of high quality end of life care.1 2 3 4 Traditionally, physicians help patients to engage in advance care planning for future health states by describing hypothetical situations such as advanced dementia and by exploring possible goals of care.5 6 This traditional approach is limited because it is challenging to realistically envision hypothetical future disease states such as dementia from verbal descriptions,7 descriptions are inconsistent among providers,8 9 10 11 12 13 14 15 and the degree to which patients understand verbal descriptions of complex medical conditions depends on their level of health literacy.Visual images can improve communication of complex health information16 17 18 19 and inform decision making at the end of life.20 21 22 In our previous investigations, a video decision support tool for advanced dementia seemed to improve communication and decision making for patients by helping them to visualise future health states.20 21 22 However, there were significant shortcomings to these studies: they were conducted in healthy middle aged patients; they used a before and after study design that did not allow comparison of the video to the standard advance care planning approach of a verbal narrative; they did not measure knowledge of the disease to test whether understanding of the disease improved; and they did not follow patients’ preferences over time.To address these shortcomings, we conducted a randomised controlled trial of the video decision support tool among a diverse group of older patients to study the video with a higher level of rigour.

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