Clinical InvestigationElectrophysiologyEducational Videos to Reduce Racial Disparities in ICD therapy Via Innovative Designs (VIVID): A randomized clinical trial
Section snippets
Video production
A multidisciplinary team of physicians, nurses, and research assistants developed the initial core content for the educational videos using a variety of resources including current national guidelines, relevant epidemiological statistics, Krames multimedia material, and other published data.22, 23 Following content development, a script and a video layout were created with assistance from staff at Duke Media Services. Each of the videos contained the same content. However, in one video, the
Results
Between January 1, 2011, and December 31, 2011, 59 patients eligible for a primary prevention ICD (37 white and 22 black) were enrolled. Of the 60 eligible patients approached for the study, 59 (98%) agreed to participate. We obtained complete data on 56 of the 59 study participants. Two white patients and 1 black patient in the UC arm were missing 1-week data from the decisional conflict scale and 1-week knowledge questionnaire. Baseline characteristics were balanced between video and UC
Discussion
In this randomized pilot study, we examined the effect of a patient-centered educational video on the decision to have an ICD placed for the primary prevention of SCA in black and white patients. Our study had 4 main findings. First, both patient-centered educational video and health care provider counseling without a video (UC) increased patient knowledge of SCA and ICD therapy in black and white patients. Second, a video-based decision aid decreased the racial disparity in the preference for
Conclusions
A patient-centered video increased black participants’ knowledge of SCA and ICDs and provided similar acceptance of ICD implantation relative to white patients. Decisional conflict was similar between black and white patients. Despite our intervention, black patients were less likely to have an ICD implanted within 90 days. Our findings should be further assessed by a large, prospective, multicenter, randomized clinical trial.
Disclosures
No disclosures to report.
Acknowledgements
We thank participants in the video, members of our focus groups, and the health care workers who reviewed the videos. We also thank Greg Hobbs for filming and editing the videotapes, Patty McAdams for drafting the physician and narrator script and for interviewing the participants for the video, and Vincent Miller for recruiting focus group members and facilitating the focus groups. Thanks also to Bob Sanderford for data entry and cleaning and to Sean O’Brien, PhD, for developing the
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Cited by (23)
Utilization of Implantable Cardioverter Defibrillators Among Patients with a Left Ventricular Assist Device: Insights From a National Database
2022, Current Problems in CardiologyCitation Excerpt :This finding is in line with multiple previous studies, including studies on Medicare patients,23 Veterans,24 and the general population,25 that have all shown that Black patients are about half as likely as White patients to receive an ICD when an indication is present. While patient preference may be partly responsible for this disparity, wherein Black patients may be more likely to decline ICD use in favor of medical treatment,26 the role of implicit biases in referrals, patient mistrust related to marginalization, and ongoing structural racism cannot be underestimated. Indeed, Black patients may have less access to high-quality healthcare, and may be subject to unconscious as well as conscious racial bias.27
Videos to reduce racial disparities in ICD therapy Via Innovative Designs (VIVID) trial: Rational, design and methodology
2020, American Heart JournalCitation Excerpt :Moreover, among black individuals in our pilot study, videos compared with usual care increased the acceptance of ICDs. Conversely, in white individuals, there was no difference in knowledge, decisional conflict, or acceptance of ICD therapy in the video relative to usual care.29 Sites within the United States were chosen based on several criteria: (1) black individuals represent at least 25% of the population within 30 miles of the clinic/health system; (2) prior experience with clinical trials of ICD therapy; and (3) ability to recruit black patients eligible for a primary prevention ICD based on their hospital services provided annually, and prior experience recruiting underrepresented racial and ethnic groups in clinical trials.
Implementation of patient education software in an anticoagulation clinic to decrease visit times for new patient appointments
2019, Patient Education and CounselingImpact of video on the understanding and satisfaction of patients receiving informed consent before elective inpatient coronary angiography: A randomized trial
2018, American Heart JournalCitation Excerpt :A pilot study aimed to show that an educational video could improve patients' knowledge of sudden cardiac arrest and Implantable Cardioverter Defibrillator (ICD). For this purpose, a 13-item questionnaire was specifically designed and the authors concluded that patient-centered video increased participants' knowledge.8 One recent randomized study analyzed the impact of a video support tool on patients' decision-making regarding advanced heart failure.26
Video-based patient decision aids: A scoping review
2018, Patient Education and Counseling
RCT# NCT00918125.
Gregg C. Fonarow, MD, served as guest editor for this article.
Funding support: This project was supported in part by a research grant from Medtronic, Inc. Additional funding was provided by cooperative agreement number 1U18HS016964 from the Agency for Healthcare Research and Quality (AHRQ). Neither AHRQ nor Medtronic, Inc, has evaluated the videos, designed the evaluation process, assisted in data collection or analysis, or provided input into this paper. The content is solely the responsibility of the authors and does not necessarily represent the official views of the AHRQ or Medtronic, Inc.