Background: Health literacy is the foundation for discussing and reaching decisions regarding future care in advance care planning (ACP). Objectives: This cluster randomized controlled trial compared the effects of a video decision aid with those of verbal narratives accompanied by photos in preparing community-dwelling Chinese adults for ACP. Setting and Subjects: Adults aged 60 years or older who were capable of communicating and decision making (n = 182). Methods: The study was conducted in eight community centers in Hong Kong from April to December 2018. The primary outcome was readiness for ACP. Secondary outcomes included knowledge of and decisional conflict regarding end-of-life care. Results: In both groups, significant improvements were noted in the readiness to discuss (β = 0.52, 95% confidence interval [CI] = 0.18 to 0.87, p = 0.003) and document (β = 0.52, 95% CI = 0.13 to 0.90, p = 0.008) end-of-life care preferences and knowledge (β = 0.85, 95% CI = 0.50 to 1.21, p < 0.001); in addition, decisional conflicts significantly decreased (β = 0.87, 95% CI = 0.49 to 1.25, p < 0.001). The video group demonstrated a greater improvement than the verbal group only in the knowledge score (β = 0.55, 95% CI = 0.08 to 1.02, p = 0.023). Conclusions: The findings showed that both video decision aids and verbal narratives accompanied by photos are effective ways to prepare older Chinese adults for ACP, although the video format was more effective for knowledge transfer. More work is needed to evaluate the sustained effects of these education interventions. Clinical Trial: This trial was registered at ISRCTN14628950.
Keywords: advance care planning; decision aid; health literacy; readiness.