Advancing Discussions Using a Video-Based Support Tool About End-of-Life Care (ADVISE): Protocol for a Single-Center Randomized Controlled Trial
Bibliographic record
Abstract
BACKGROUND More than 950,000 adults over 65 years of age are hospitalized each year after injury. Recommended care for this vulnerable group includes discussion of their goals for life-sustaining care (“code status”) upon admission, but most older patients do not participate in adequate code status discussions. Randomized trials have demonstrated that video-based interventions are associated with better patient knowledge and improved alignment of patient preferences for life-sustaining treatment; however, there are limited data on the effectiveness of these interventions in acutely injured patients. OBJECTIVE This trial will evaluate the effectiveness and implementation considerations of a video conversation aid to enhance communication among trauma care providers, patients, and surrogate decision-makers regarding cardiopulmonary resuscitation (CPR) and code status decisions. METHODS This is a single-center randomized controlled trial evaluating the use of a video conversation aid to facilitate discussions of code status. The video intervention will be compared to usual care in the largest feasible pilot randomized controlled trial with the goal of estimating its benefit for patient-centered outcomes. All trauma patients aged 65 years and older admitted following injury are eligible. Incarcerated people, patients with existing do-not-resuscitate or do-not-intubate orders, patients admitted while in hospice care, and patients not expected to survive over 24 to 48 hours will be excluded. The primary outcome is transitions in code status. Secondary outcomes will include perceived success of CPR, video acceptability and effectiveness, knowledge of life-sustaining care outcomes and complications following CPR, participant desire for more information regarding life-sustaining care, hospital-free days, intensive care unit–free days, ventilator-free days, discharge disposition, decisional conflict score, and rate of interventional procedures (eg, tracheostomy, feeding tube placement, and dialysis initiation). RESULTS The ADVISE (Advancing Discussions Using a Video-Based Support Tool About End-of-Life Care) trial was funded in February 2025 via the Learning Healthcare System grant from the University of Texas Health Science Center at Houston. Enrollment began on March 17, 2025, and it is estimated to conclude on May 1, 2026. CONCLUSIONS The ADVISE trial builds on previous research on older trauma patients and advanced care planning using a video intervention to enhance code status discussions. We anticipate that our video aid tool will enhance patients’ and surrogate decision-makers’ knowledge of advanced care discussions. CLINICALTRIAL ClinicalTrials.gov NCT06804226; https://clinicaltrials.gov/study/NCT06804226 INTERNATIONAL REGISTERED REPORT DERR1-10.2196/87690
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How this classification was reachedexpand
Full frame machine prediction
Teacher imitationNot calibrated prevalence, not ground truth. Human validation pending. The Gemma side is a direct model label for every work in the frame, read from the title-only record. The Codex side is a classifier learned from the 10,348 direct Codex labels and calibrated to design-weighted sample rates; fields without enough sample support carry no Codex call. Candidate is the union of the two sides; consensus is their intersection. These outputs are machine_predicted_unvalidated and are not human labels.
Distilled classifier scores by category (both heads)
| Category | Codex | Gemma |
|---|---|---|
| Metaresearch | 0.069 | 0.071 |
| Meta-epidemiology (narrow) | 0.009 | 0.005 |
| Meta-epidemiology (broad) | 0.016 | 0.009 |
| Bibliometrics | 0.004 | 0.005 |
| Science and technology studies | 0.005 | 0.005 |
| Scholarly communication | 0.008 | 0.006 |
| Open science | 0.005 | 0.003 |
| Research integrity | 0.010 | 0.012 |
| Insufficient payload (model declined to judge) | 0.097 | 0.016 |
Machine scores (provisional)
The two teacher heads of the student model, read on this work. A score orders the frame for review; it never asserts a category, and the validation status ships verbatim with every row.
Baseline scores from an immature model (maturity gate not passed, 7 training rounds). Scores rank; they never assert a category.
score_only:v0-immature-baseline · verbatim from the scoring run: score_only means the number may rank works, and no category label ships from itClassification
machine, unvalidatedMachine predicted; a candidate call from one source (direct Gemma or distilled Codex), not a consensus.
How this classification was reached, model by model and score by score, is at the end of the page under "How this classification was reached".