Educational videos may help bridge ICD racial gap

Educational videos may play a role in making implantable cardioverter-defibrillators (ICDs) a more acceptable option to black patients after a sudden cardiac arrest (SCA), according to researchers in North Carolina. Although blacks have a higher rate of SCA, they are much less likely than whites to opt for an ICD.

The authors, led by Kevin L. Thomas, MD, at Duke University School of Medicine in Durham, N.C., found that informational videos improved overall patient knowledge about SCA and ICDs and made black patients as accepting of the procedure as whites are. Their study was published in the July issue of American Heart Journal.

However, the videos had little impact on actual usage—blacks were still not as likely as whites to have an ICD implantation within 90 days.

“The extent to which higher refusal rates in black individuals reflect either different cultural preferences or being uninformed about health care decisions has not been fully elucidated,” the authors wrote.

In an effort to learn more about the reasons behind the disparity, the researchers produced informational videos and showed them to a group of 39 patients (15 black and 24 white) between January and December 2011. The videos included animation, physician information and patient testimonials. One video featured black physicians and patients; the other’s participants were white.

They then compared that video-viewing group to a group of 20 patients—7 black and 13 white—who received only physician counseling and usual care.

The follow-up consisted of a one-week posttest questionnaire, followed by an appointment or phone call to determine whether or not patients wanted an ICD. Researchers also administered a decisional conflict scale they developed for this study.

Among the patients who viewed the videos, blacks were just as likely to want an ICD (60 percent, compared with 79.2 percent of whites). But in the group who received only physician counseling, 49.2 percent of blacks wanted an ICD vs. 84.6 percent of whites.

Ultimately, nearly 80 percent of the study participants received an ICD within three months. There were significantly more whites treated with an ICD from both the video group and the usual care group.

The authors acknowledged several limitations of their study. First, it included a small sample size. In addition, the participants were from only three centers in North Carolina, which limited generalizability.

It is also possible that being featured in a video may have led the physicians to change their usual patterns of behavior and communication.

They also did not use a validated decisional conflict scale and instead developed their own modified version of a scale used with other medical conditions.

Despite the study’s limitations, they encouraged a closer look at this type of video intervention in a larger trial.

“Our study demonstrates that randomized testing of an intervention to address disparities in ICD therapy is feasible and necessary to better understand the genesis and potential solutions to eliminating these disparities,” they concluded.