Do Life-sustaining Treatment Orders Match Patient and Surrogate Preferences? The Role of POLST.
J Gen Intern Med
; 36(2): 413-421, 2021 02.
Article
em En
| MEDLINE
| ID: mdl-33111241
ABSTRACT
BACKGROUND:
It is essential to high-quality medical care that life-sustaining treatment orders match the current, values-based preferences of patients or their surrogate decision-makers. It is unknown whether concordance between orders and current preferences is higher when a POLST form is used compared to standard documentation practices.OBJECTIVE:
To assess concordance between existing orders and current preferences for nursing facility residents with and without POLST forms.DESIGN:
Chart review and interviews.SETTING:
Forty Indiana nursing facilities (29 where POLST is used and 11 where POLST is not in use).PARTICIPANTS:
One hundred sixty-one residents able to provide consent and 197 surrogate decision-makers of incapacitated residents with and without POLST forms. MAIN MEASUREMENTS Concordance was measured by comparing life-sustaining treatment orders in the medical record (e.g., orders about resuscitation, intubation, and hospitalization) with current preferences. Concordance was analyzed using population-averaged binary logistic regression. Inverse probability weighting techniques were used to account for non-response. We hypothesized that concordance would be higher in residents with POLST (n = 275) in comparison to residents without POLST (n = 83). KEYRESULTS:
Concordance was higher for residents with POLST than without POLST (59.3% versus 34.9%). In a model adjusted for resident, surrogate, and facility characteristics, the odds were 3.05 times higher that residents with POLST had orders for life-sustaining treatment match current preferences in comparison to residents without POLST (OR 3.05 95% CI 1.67-5.58, p < 0.001). No other variables were significantly associated with concordance.CONCLUSIONS:
Nursing facility residents with POLST are significantly more likely than residents without POLST to have concordance between orders in their medical records and current preferences for life-sustaining treatments, increasing the likelihood that their treatment preferences will be known and honored. However, findings indicate further systems change and clinical training are needed to improve POLST concordance.Palavras-chave
Texto completo:
1
Coleções:
01-internacional
Base de dados:
MEDLINE
Assunto principal:
Diretivas Antecipadas
/
Planejamento Antecipado de Cuidados
Tipo de estudo:
Prognostic_studies
Aspecto:
Ethics
/
Patient_preference
Limite:
Humans
País/Região como assunto:
America do norte
Idioma:
En
Revista:
J Gen Intern Med
Ano de publicação:
2021
Tipo de documento:
Article