Video Inspired Discussions About Ethical Outcomes in Pediatrics (VIDEO-PEDS)

May 11, 2026 updated by: Joanne Wolfe, MD, MPH, Massachusetts General Hospital

A Multisite RWCT Comparing the Effectiveness of a Goals of Care Video and Navigator Intervention, the VIDEO-PEDS Experience, Versus Usual Care in Pediatric Cancer

The goal of this clinical trial is to learn if the VIDEO-PEDS intervention works to improve Goals of Care communication between clinicians and parents of children with cancer.

The main questions it aims to answer are:

Does the intervention improve Goals of Care documentation? Does it improve patient outcomes (including less invasive preferences for resuscitation and interventions, less hospital utilization, and more palliative care and hospice use)? Does it improve parent outcomes (including health satisfaction and feeling heard and understood per survey scores)?

Study Overview

Status

Recruiting

Conditions

Intervention / Treatment

Detailed Description

Background

Parents of children with advanced cancer often face challenging decisions about goals of care (GOC) amidst high stress and limited understanding of medical interventions. Despite evidence that early and informed GOC discussions improve end-of-life experiences and align care with family values, such conversations remain infrequent in pediatric oncology. Barriers such as communication gaps, literacy challenges, and cultural differences exacerbate disparities, particularly among African American, Hispanic, and rural populations. The Video Images about Decisions for Ethical Outcomes in Pediatrics (VIDEO-PEDS) trial aims to address these gaps through an innovative video-based intervention. Similar interventions were effective in an adult cancer population.

Aims

  1. To refine and finalize a theory-based video decision aid tailored to parents of children with advanced cancer.
  2. To evaluate the feasibility, acceptability, and preliminary impact of the intervention through a pilot study.
  3. To conduct a randomized waitlist-controlled trial (RWCT) assessing the effectiveness of the intervention in improving GOC communication and documentation.

Design

This study will be conducted in two phases:

  1. Pilot Study

    • Design: A mixed-methods study to test the feasibility and acceptability of the intervention among 27 parents (9 per site). Focus groups with 36 parents (12 per site) will be conducted in English and Spanish. Clinician providers will be interviewed.
    • Purpose: To refine the intervention and ensure its appropriateness for the larger trial.

  2. Randomized Waitlist-Controlled Trial (RWCT)

    • Design: A multicenter, parallel-group RCT with a waitlist control.
    • Purpose: To evaluate the impact of the intervention on GOC documentation and patient- and parent-centered outcomes.

Setting

The study will take place across three diverse healthcare systems:

  1. Dana-Farber Cancer Institute/Boston Children's Hospital
  2. Children's Healthcare of Atlanta/Aflac Cancer Center
  3. University of Alabama at Birmingham These sites were selected because of their robust pediatric oncology programs and diverse patient populations, including African American, Hispanic, and rural families.

Participants/Subjects

  1. Pilot Study:

    Parents of 27 children (9 per site) aged 0-12 years with cancer will be recruited to test the intervention.

  2. RWCT:

    • A total of 504 parents (168 per recruitment cycle across three cycles) will be enrolled.
    • Stratification will ensure representation of African American, Hispanic, and rural populations.

Interventions

  1. Pilot Study:

    • Intervention: A video decision aid coupled with structured conversations facilitated by trained Navigators. The video provides education about GOC, focusing on values-based decision-making and specific interventions (e.g., CPR, intubation).
    • Duration: Parents will view the video and engage in one or more conversations with the Navigator over three months.

  2. RWCT:

    • Intervention: Refined video decision aid with Navigator-led discussions over a nine-month period.
    • Control: Usual care, with the intervention provided to the waitlist control group after nine months.

Methods Patients will be screened from oncology patient lists at the three enrolling sites. A research assistant will complete an eligibility checklist for all meeting general criteria after an initial screening. For those potentially eligible, an eligibility checklist will be reviewed by a site PI and validated (eventually through REDCap). Once deemed eligible, an opt-out email is sent to the primary clinician for permission to approach. Invitations will then be sent by mail or email, followed by an in-person or phone approach. Prospective verbal informed consent will be obtained from the parents who choose to participate. Participation then involves viewing the Video. Video cards (inexpensive disposable devices) may be provided to reduce barriers to participation. Following the viewing, an extensively trained Navigator from the research team will discuss the goals of care broadly with the parent throughout the study duration, prompting engagement with the primary oncologist.

Development Phase:

  • Parent focus groups led by site PIs will be held in English and Spanish via Zoom and audio recorded. The video will be shown and discussed following a semi-structured guide.
  • The video will be refilmed to incorporate feedback from the focus groups.
  • Workflows will be refined and study infrastructure will be developed further for the next phase.

Pilot Study:

o An abbreviated 3-month version of the intervention will be tested, including pre- and post-study surveys.

RWCT:

The investigators will conduct a large, pragmatic, randomized, waitlist-controlled trial (RWCT). The investigators will conduct three cycles of nine months. Thus, over the course of 27 months, three cycles of unique patients will be randomized (9 months per cycle x 3 cycles = 27 months). The recruitment period is 36 months to account for the last nine months of intervention for Waitlist-Controls in the last cycle. At the start of each of the three cycles, the investigators will ask each health system to curate and finalize a list of all eligible patients. For each cycle, one-third of the total 504 (i.e., N=168) will be randomized in 1:1 assignment, stratified by health system and demographic characteristics (African American, Hispanic, and rural) to Waitlist-Control or GOC Video Intervention.

A subgroup of 136 parents (total) will be asked to complete a survey via REDCap. These parents will be evenly divided between the two arms of the study and the three study sites. Participants will receive a self-administered survey via email/mailing at the beginning of a nine-month period and again at the end.

A subgroup of 12 parents (total) will be asked to complete an audio-recorded exit interview. The investigators will ask parents to comment on the perceived usefulness of the intervention, whether anything was learned, and how communication may have changed with the participant's clinicians since the intervention.

A subgroup of 25 parents (total) will have the Navigator conversation audio-recorded for intervention fidelity. A subset of these will be transcribed and further analyzed.

Stakeholder Interviews will be conducted with 18 clinicians (6 per site) including key clinical leaders of services.

Data Analysis:

  • Mixed-methods process evaluation will use the RE-AIM framework to assess implementation.
  • Descriptive statistics will be used for feasibility outcomes (e.g., recruitment, and retention rates).
  • Comparative analysis of primary and secondary outcomes between intervention and control groups using intention-to-treat principles.
  • Natural Language Processing technology will be used to identify outcomes in the EHR.

Outcomes

While more detail on Outcomes exists in that section, the primary outcome for the RWCT is the presence of GOC documentation in the EHR. Secondary outcomes include:

  • Implementation outcomes: Feasibility, acceptability, and fidelity of the intervention.
  • Parent-reported outcomes: Satisfaction with communication, perceived knowledge, and decisional certainty.
  • Patient outcomes: Location of care at the end of life, alignment of care with stated goals.

Exploratory analyses will examine subgroup effects among African American, Hispanic, and rural participants, as well as the cost-effectiveness and scalability of the intervention.

Study Type

Interventional

Enrollment (Estimated)

567

Phase

  • Not Applicable

Contacts and Locations

This section provides the contact details for those conducting the study, and information on where this study is being conducted.

Study Contact

Study Contact Backup

Study Locations

  • United States
    • Alabama
      • Birmingham, Alabama, United States, 35233
        • Recruiting
        • Children's of Alabama at Birmingham
        • Contact:
        • Principal Investigator:
          • Emily Johnston, MD
    • Georgia
      • Atlanta, Georgia, United States, 30342
        • Recruiting
        • Children's Hospital of Atlanta
        • Contact:
        • Principal Investigator:
          • Katharine Brock, MD
    • Massachusetts
      • Boston, Massachusetts, United States, 02215
        • Recruiting
        • Dana Farber Cancer Institute
        • Contact:
        • Principal Investigator:
          • Jennifer Snaman, MD
        • Sub-Investigator:
          • Ijeoma Eche
        • Sub-Investigator:
          • Charlotta Lindvall
    • New Hampshire
      • Lebanon, New Hampshire, United States, 03756
        • Active, not recruiting
        • Dartmouth Hitchcock Medical Center

Participation Criteria

Researchers look for people who fit a certain description, called eligibility criteria. Some examples of these criteria are a person's general health condition or prior treatments.

Eligibility Criteria

Ages Eligible for Study

  • Child
  • Adult
  • Older Adult

Accepts Healthy Volunteers

No

Description

Inclusion Criteria:

Patient

  • Age 0-12 years
  • Diagnosed with any type or stage of cancer
  • Receiving cancer directed treatment

Parent

  • Decision maker for the child.
  • Biological parent, step-parent, legal guardian (e.g., adoptive parent), or grandparent with medical consent authority.
  • Has a child meeting the child inclusion criteria listed above.
  • Able to communicate in English or Spanish (the languages of the video decision aids).

Exclusion Criteria:

Patient

  • Not receiving primary medical care from the cancer clinic (e.g., second-opinion consultations only)
  • Already referred to and fully consulted by the palliative care team
  • Prognosis of less than a 2-month life expectancy

Parent

  • Visually impaired beyond 20/200 corrected and unable to view the video (note: hearing impaired is not an exclusion as the videos are closed captioned).
  • Psychological state not appropriate for GOC discussions, as determined by the primary oncologist per the opt-out.
  • Participants who do not speak English or Spanish

Study Plan

This section provides details of the study plan, including how the study is designed and what the study is measuring.

How is the study designed?

Design Details

  • Primary Purpose: Supportive Care
  • Allocation: Non-Randomized
  • Interventional Model: Parallel Assignment
  • Masking: Single

Arms and Interventions

Participant Group / Arm
Intervention / Treatment
Experimental: UH3 RWCT Arm - Intervention
This group will receive the VIDEO-PEDS intervention.
Other: VIDEO-PEDS
Following enrollment, parents will receive a link to view the refined video decision aid that is designed to prompt parents to think about their goals of care for their child with cancer, and then to react by engaging in communication with a trained member of the research team called the Navigator and eventually their clinical team over the course of the 9-month study duration.
No Intervention: UH3 RWCT Arm - Control
This group will receive usual care until the 9-month wait period expires.
Other: UG3 Pilot Intervention
This group will receive the 3-month pilot version of the VIDEO-PEDS intervention.
Other: VIDEO-PEDS pilot
This is the 3-month pilot version of the intervention, which will be further developed for the eventual RWCT.
Other: UG3 Focus Group
This group will participate in the virtual parent focus groups.
Other: Focus Group
Parents will view the Video aid and provide fascilitated feedback in an audio-recorded virtual group setting.

What is the study measuring?

Primary Outcome Measures

Outcome Measure
Measure Description
Time Frame
Goals-of-Care Discussion
Time Frame: At the end of Cycles 1, 2, and 3 (each cycle is 9 months)
Percentage of parents who held conversations with their medical team about goals, values, or priorities for treatment and outcomes as per documentation in the medical record.
At the end of Cycles 1, 2, and 3 (each cycle is 9 months)
Code Status Limitation
Time Frame: At the end of Cycles 1, 2, and 3 (each cycle is 9 months)
Percentage of parents who communicate limitations to cardiopulmonary resuscitation and intubation with their medical team as per documentation in the medical record.
At the end of Cycles 1, 2, and 3 (each cycle is 9 months)
Palliative Care
Time Frame: At the end of Cycles 1, 2, and 3 (each cycle is 9 months)
Percentage of parents who mention a visit with a specialty palliative care clinician, mention of specialist palliative care discussion, or patient preferences regarding seeing a palliative care clinician to their medical team as per documentation in the medical record.
At the end of Cycles 1, 2, and 3 (each cycle is 9 months)
Time-Limited Trial
Time Frame: At the end of Cycles 1, 2, and 3 (each cycle is 9 months)
Percentage of parents who engage in conversations with their medical team about the use of a treatment or procedure for a set amount of time with a pre-defined goal and plan related to the outcome at the end of the trial as per documentation in the medical record.
At the end of Cycles 1, 2, and 3 (each cycle is 9 months)

Secondary Outcome Measures

Outcome Measure
Measure Description
Time Frame
Acceptability themes from qualitative data
Time Frame: 2 years
For the development phase, qualitative group interviews will yield information about participant preferences. For the pilot phase, qualitative individual interviews will yield information about participant preferences after a 3-month study duration.
2 years
Feasibility by % of parents
Time Frame: 2 years
Feasibility will be assessed as ability to identify, recruit, and retain participants as a percentage. 70% of those screened should be eligible for approach after the Validation and Opt-out Steps. 70% approached should agree to participate. 70% should complete the study. (<30% should be lost to follow-up or withdraw from the study.)
2 years
Parent Satisfaction scores
Time Frame: 2 years
A parent survey will measure how parents felt heard and understood by the medical team and how satisfied they were with the care received using five validated items from the measure Feeling Heard and Understood and two items from the Survey about Caring for Children with Cancer (SCCC) all answered on a 5-point Likert Scale. Scores range from 0 to 100 with 0 being the lowest satisfaction.
2 years

Collaborators and Investigators

This is where you will find people and organizations involved with this study.

Sponsor

Massachusetts General Hospital

Collaborators

National Cancer Institute (NCI)
Yale University
Dana-Farber Cancer Institute
University of Alabama at Birmingham
Emory University
Dartmouth-Hitchcock Medical Center
Children's Healthcare of Atlanta

Investigators

  • Principal Investigator: Angelo Volandes, MD, Dartmouth-Hitchcock Medical Center

Publications and helpful links

The person responsible for entering information about the study voluntarily provides these publications. These may be about anything related to the study.

General Publications

Study record dates

These dates track the progress of study record and summary results submissions to ClinicalTrials.gov. Study records and reported results are reviewed by the National Library of Medicine (NLM) to make sure they meet specific quality control standards before being posted on the public website.

Study Major Dates

Study Start (Actual)

May 5, 2026

Primary Completion (Estimated)

January 15, 2030

Study Completion (Estimated)

April 15, 2030

Study Registration Dates

First Submitted

January 7, 2025

First Submitted That Met QC Criteria

January 14, 2025

First Posted (Actual)

January 22, 2025

Study Record Updates

Last Update Posted (Actual)

May 14, 2026

Last Update Submitted That Met QC Criteria

May 11, 2026

Last Verified

May 1, 2026

More Information

Terms related to this study

Keywords

Additional Relevant MeSH Terms

Other Study ID Numbers

  • 24-313
  • 1UG3CA286852-01A1 (U.S. NIH Grant/Contract)

Plan for Individual participant data (IPD)

Plan to Share Individual Participant Data (IPD)?

NO

Drug and device information, study documents

Studies a U.S. FDA-regulated drug product

No

Studies a U.S. FDA-regulated device product

No

This information was retrieved directly from the website clinicaltrials.gov without any changes. If you have any requests to change, remove or update your study details, please contact register@clinicaltrials.gov. As soon as a change is implemented on clinicaltrials.gov, this will be updated automatically on our website as well.

Clinical Trials on Pediatric Cancer

Clinical Trials on VIDEO-PEDS

Search Similar Trials

Sponsors and Collaborators

Medical Conditions

Drug Interventions

CROs by country

CROs in Gabon

Conditions

Rare Diseases

Drug Interventions

Dietary Supplements

Sponsor/Collaborators

Locations

Subscribe