Elderly access to health services is often limited by mobility and an inability to afford healthcare services, especially for those who require prolonged care [ 25].
The definition of LTCF, facility characteristics, and resident population differed between studies, however LTCF generally referred to facilities that provided prolonged care for individuals who required daily living and/or nursing care support.
The primary health care available is usually not sufficient to address most chronic diseases, such as cardiovascular disease (CVD), diabetes and cancer, which require prolonged care and expensive treatment [ 27, 28].
The first option, life prolonging care, was described as aiming to prolong life at any cost.
There were three options for preferences for goals of care: life prolonging care, limited care, and comfort care (see appendix on bmj.com).
Results Among participants receiving the verbal narrative alone, 68 (64%) chose comfort care, 20 (19%) chose limited care, 15 (14%) chose life prolonging care, and three (3%) were uncertain.
In the video group, 8186%6%) chose comfort care, eight (9%) chose limited care, four (4%) chose life prolonging care, and one (1%) was uncertain (χ=13.0, df=3, P=0.003).
Main outcome measures Preferred goal of care: life prolonging care (cardiopulmonary resuscitation, mechanical ventilation), limited care (admission to hospital, antibiotics, but not cardiopulmonary resuscitation), or comfort care (treatment only to relieve symptoms).
Among the 106 participants receiving only the verbal narrative, 68 (64%) chose comfort care, 20 (19%) chose limited care, 15 (14%) chose life prolonging care, and three (3%) were uncertain of their preferences.
Among the 94 who also saw the video, 8186%6%) chose comfort care, eight (9%) chose limited care, four (4%) chose life prolonging care, and one (1%) was uncertain of her preferences (χ=13.0, df=3; P=0.003).
Specific attention is paid to patients receiving life prolonging care, not just in line with a continuously heightened or intensified attention to discussion topics during the process of treatment from curative to ultimately terminal care.
