WHY DON'T END-OF-LIFE CONVERSATIONS GO VIRAL? A SYSTEMATIC REVIEW OF YOUTUBE

Tuesday, October 21, 2014
Poster Board # PS3-49

Imogen Mitchell, MD, PhD1, Anne Schuster, MHS1, Thomas Lynch, PhD2, Katherine Smith, PhD3, John F.P. Bridges, PhD4 and Rebecca Aslakson, MD, PhD5, (1)Department of Health Policy and Management, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, (2)Department of Anesthesiology and Critical Care & Palliative Care Program, Kimmel Cancer Center at Johns Hopkins, Johns Hopkins School of Medicine, Baltimore, MD, (3)Department of Health, Behavior and Society, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, (4)Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, (5)Department of Anesthesiology and Critical Care, Johns Hopkins Hospital, Baltimore, MD, USA, Baltimore, MD
Purpose: To identify videos concerning advance care planning (ACP) and synthesize existing video content and style elements in preparation for developing a perioperative ACP decision aid.

Method: Informed by stakeholder engagement, two researchers searched YouTube for videos pertaining to ACP using predefined search terms and snowballing techniques. Videos identified through the search were reviewed and deemed ineligible for analysis if they: targeted healthcare providers; contained irrelevant content; focused on viewers under the age of 18; were longer than seven minutes; had received fewer than 150 views; or were not in English. For each video, two investigators independently abstracted general information as well as content and stylistic characteristics.

Result: Stakeholders preferred videos that engaged viewers by using: upbeat music, dynamic voices, personal stories delivered by real people as opposed to actors, and content framed around living and quality of life. The systematic review identified 23,100 videos with 213 retrieved for assessment and 42 satisfying the eligibility criteria. The majority of videos had been posted on YouTube since 2010 and had been produced by organizations in the United States (71%). Number of views ranged from 171 to 10,642. Predominantly, the videos did not include individuals from a diversity of racial or ethnic backgrounds, and individuals were primarily perceived to be white (93%). Most videos used a documentary style and featured healthcare providers (60%) rather than patients (14%) or families (40%). A minority of videos (29%) used upbeat or hopeful music. They frequently focused on completing legal medical documents (86%).

Conclusion: As none of the ACP videos on YouTube had gone viral, videos seemingly lacked content and style elements that piqued viewers’ attention and spurred them on to share the videos with others. Indeed, a relatively small number of videos contained elements endorsed by our stakeholders or reflected the racial diversity of the United States population. In emphasizing the completion of legal medical documents, videos failed to support more meaningful ACP. Further research is needed to understand the features of videos that will engage patients and the community at large with ACP and also aid better decision-making.

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