Do Life-sustaining Treatment Orders Match Patient and Surrogate Preferences? The Role of POLST

Hickman, Susan E.; Torke, Alexia M.; Sachs, Greg A.; Sudore, Rebecca L.; Tang, Qing; Bakoyannis, Giorgos; Smith, Nicholette Heim; Hammes, Bernard J.

doi:10.1007/s11606-020-06292-1

Cited by 17 publications

(19 citation statements)

References 42 publications

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“…POLST offers a unique opportunity to identify and better understand the reasons for discordance between current preferences and orders by providing clear documentation of previous decisions. In order to better understand the reasons for discordance between current preferences and documentation, a qualitative study was undertaken as part of a larger, NIH‐funded study of POLST decision‐quality in the nursing facility setting 7 …”

Section: Introductionmentioning

confidence: 99%

Reasons for discordance and concordance between POLST orders and current treatment preferences

Hickman

Torke

Smith

et al. 2021

J American Geriatrics Society

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Background The reasons for discordance between advance care planning (ACP) documentation and current preferences are not well understood. The POLST form offers a unique opportunity to learn about the reasons for discordance and concordance that has relevance for POLST as well as ACP generally. Design Qualitative descriptive including constant comparative analysis within and across cases. Setting Twenty‐six nursing facilities in Indiana. Participants Residents (n = 36) and surrogate decision‐makers of residents without decisional capacity (n = 37). Measurements A semi‐structured interview guide was used to explore the reasons for discordance or concordance between current preferences and existing POLST forms. Findings Reasons for discordance include: (1) problematic nursing facility practices related to POLST completion; (2) missing key information about POLST treatment decisions; (3) deferring to others; and (4) changes over time. Some participants were unable to explain the discordance due to a lack of insight or inability to remember details of the original POLST conversation. Explanations for concordance include: (1) no change in the resident's medical condition and/or the resident is unlikely to improve; (2) use of the substituted judgment standard for surrogate decision‐making; and (3) fixed opinion about what is “right” with little to no insight. Conclusion Participant explanations for discordance between existing POLST orders and current preferences highlight the importance of adequate structures and processes to support high quality ACP in nursing facilities. Residents with stable or poor health may be more appropriate candidates for POLST than residents with a less clear prognosis, though preferences should be revisited periodically as well as when there is a change in condition to help ensure existing documentation is concordant with current treatment preferences.

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Section: Introductionmentioning

confidence: 99%

Reasons for discordance and concordance between POLST orders and current treatment preferences

Hickman

Torke

Smith

et al. 2021

J American Geriatrics Society

Self Cite

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“…Furthermore, her physician was unfamiliar with the online Physician Orders for Life-Sustaining Treatment (POLST) form. 32 Through several conversations, the nurse elicited that her goals were to maintain her independence for as long as possible. The telephonic nurse provided MA with emotional support and used motivational interviewing techniques to discuss different approaches to initiate a sensitive conversation with her husband.…”

Section: Case Presentationsmentioning

confidence: 99%

“…She had never spoken with her husband about advance directives and was not confident whether he would agree to uphold her wishes. Furthermore, her physician was unfamiliar with the online Physician Orders for Life-Sustaining Treatment (POLST) form 32 . Through several conversations, the nurse elicited that her goals were to maintain her independence for as long as possible.…”

Section: Case Presentationsmentioning

confidence: 99%

Nurse-Led Telephonic Palliative Care

Yamarik

Tan

Brody

et al. 2022

J Hosp Palliat Nurs

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Americans near the end of life experience high rates of nonbeneficial, burdensome, and preventable hospital-based care. If patients' goals of care are unknown or unclear, they have higher rates of hospitalization at the end of life. The demand for palliative care has grown exponentially because of its impact on quality of life, symptom burden, and resource use, requiring the development of new palliative care models. Nurses' holistic outlook and patient-centered focus make them ideal to deliver telephonic palliative care. This article discusses 4 cases delivered by a nurse-led telephonic palliative care program, a part of the Emergency Medicine Palliative Care Access project, which is a randomized controlled trial comparing outpatient palliative care with nurse-led telephonic case management after an emergency department visit. Telephonic nurses discuss patients' goals, fears, hopes, and concerns regarding their illness and its trajectory that inform decisions for future interventions and treatments. In addition, they share this information with the patients' surrogate decision-makers and clinicians to facilitate care coordination and symptom management. For seriously ill patients, nurses' abilities and expertise, as well as the difficulties of providing care through in-person models of palliative care delivery, make a nurse-led telephonic model an optimal option.

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“…Physician Orders for Life-Sustaining Treatment (POLST) can effectively transmit decisions about aggressiveness of care for nursing home (NH) residents across time and settings. [1][2][3] However, POLST requires valid completion, continuity, and availability to ensure care consistent with goals. 4,5 These aspects of POLST use have been studied only in narrow samples over brief periods 6 or through registries.…”

Section: Introductionmentioning

confidence: 99%