Language Variations in Describing Nutrition and Hydration Interventions in State Physician Orders for Life Sustaining Treatment Forms and the Implications for Advanced Dementia Patients.

Background: Research suggests that language can impact medical decision-making, but few studies exist describing the variations in language to describe end-of-life nutrition and hydration interventions. The language contained in the Physician Orders for Life Sustaining Treatment (POLST) form varies across states, but this variation has not yet been fully analyzed. This investigation has implications for communicating with surrogates about the insertion of feeding tubes in advanced dementia patients, a common procedure in this population despite its potentially high risks and low benefits. Objective: Identify and analyze the variations in language related to end-of-life nutrition and hydration interventions in state POLST forms. Design: Descriptive study. Measurements: The most up-to-date POLST forms for each of the 50 US states and the District of Columbia as of August 2022 were analyzed for their descriptions of end-of-life nutrition and hydration interventions. Results: Fifty out of 51 (98%) forms referenced nutrition and/or hydration interventions. Four main modifiers of the word "nutrition" and/or "hydration" were identified: artificial (32%), artificially administered (56%), medically administered (14%), and assisted/medically assisted (18%). Forty-eight (96%) forms indicated an explicit option to forgo feeding tubes, and all of these forms described doing so with negatively valenced language. Conclusions: The language describing end-of-life nutrition and hydration interventions and feeding tubes in state POLST forms is insufficiently specific and varies significantly across the country. These terms are at best ambiguous and at worst imply incorrect information. More precise language may assist in the difficult discussion between physicians and surrogates about inserting feeding tubes in advanced dementia patients.

Team Efficacy Profiles: Congruence Predicts Objective Performance of Athlete Pairs.

Efficacy beliefs targeting personal (self-efficacy), teammates' (other-efficacy), and conjoint (collective efficacy) abilities are each associated with performance of athlete pairs. The purpose of this study was to examine (a) congruence/incongruence of efficacy beliefs between athletes in a pair as a predictor of quality of individual and team performance and (b) quality of performance relative to efficacy congruence at high, moderate, and low levels of efficacy. Eighty-two cheerleading pairs, composed of one base and one flyer, completed questionnaires assessing self-, other, and collective efficacy prior to a national collegiate competition. Individual and team performances were assessed using objective criteria. Polynomial regression analyses indicated that team performance was predicted by congruence of (a) both athletes' collective efficacy beliefs and (b) base self-efficacy and flyer other efficacy. Findings supported that congruence at moderate to high levels of efficacy was associated with better performance relative to incongruent efficacy beliefs across the two athletes.