The Quality of Physician Orders for Life-Sustaining Treatment Decisions: A Pilot Study

Abstract

Background: Physician Orders for Life-Sustaining Treatment (POLST) forms are used to document patient treatment preferences as medical orders. Prior research demonstrates that use of POLST alters medical treatments in a way that is consistent with the POLST orders. However, there are minimal data about the quality of POLST decisions, including whether they reflect the current preferences of well-informed patients. Objective: Evaluate the quality of POLST decisions. Design: Chart abstraction; interviews. Subjects: Nursing home residents and healthcare agents of incapacitated nursing home residents (n = 28). Measurements: Characteristics of the POLST conversation were assessed. Brief vignettes were used to assess knowledge about how POLST orders guide medical treatment. Current treatment preferences were elicited and compared with the patient's POLST orders to assess discordance. Results: A majority (59%) of participants recognized the POLST form. Participants were generally accurate in their knowledge of how POLST orders guide treatment concerning cardiopulmonary resuscitation (CPR) (68%), antibiotics (74%), and artificial nutrition (79%), but less so for medical interventions (50%). Current treatment preferences were initially discordant with one or more POLST orders for 64% (18/28) of participants, but half of these discordances were resolved with further discussion (e.g., participant agreed with the existing order). Discordance by treatment decision was as follows: CPR (7%), level of medical intervention (18%), antibiotics (21%), and artificial nutrition (11%). Conclusions: Discordance between current preferences and POLST orders is complex. Interventions are needed to support high-quality POLST decisions that are informed and concordant with current preferences.

Does implementation matter if comprehension is lacking? A qualitative investigation into perceptions of advance care planning in people with cancer

“…[11] A recent American study found discordance between Physician Orders for Life Sustaining Treatment forms and current treatment preferences. [15] The objective of this study was to explore the comprehension of ACP in people with cancer who have current advance care plans. how people with cancer comprehended advance care plans.…”

Aspectos bioéticos dos cuidados em saúde às pessoas idosas ao fim da vida [Bioethical aspects of the health care provided to older adults at the end of their lives] [Aspectos bioéticos de los cuidados de salud a adultos mayores en el final de la vida]

“…Quanto à procedência dos artigos: 45,8% foram desenvolvidos em países da América do Norte 13,14,16,18,20,22,24,26,29,33,34 , 41,7% em países da Europa 15,17,21,23,25,[30][31][32]35,36 , 8,3% em países da América do Sul 27,28 e 4,2% em um país da Oceania 19 . Os países que mais publicaram sobre esta temática foram os Estados Unidos 13,14,16,18,20,22,24,26,29,33 , seguido por Portugal 17,21,25,32 e Bélgica 23,30,31,35 .…”

“…Nove estudos integram essa categoria 13,14,16,18,19,24,29,33,34 e abordam as preferências atuais das pessoas idosas e a tomada de decisão em seus cuidados ao fim da vida considerando os princípios bioéticos.…”

A Video Decision Aid for the West Virginia POST: A Randomized, Controlled Trial

“…To date however, no published studies have evaluated a decision aid for the entire POLST. Further, there is little research about the quality of POLST paradigm decisions, other than a small sample pilot study (Hickman et al, 2017) and a study evaluating an aid for section B of the West Virginia POST (Gallegos et al, 2020).…”

“…Unlike the growing research investigating the completion of POLST paradigm forms, there is relatively little research investigating the quality of the decision-making process. Hickman et al (2017) conducted a small pilot study to investigate POLST paradigm decision quality. Participants were nursing home residents and surrogate decision-makers who had completed POLST paradigm forms in the past year.…”