POLST Facilitation in Complex Care Management: A Feasibility Study
| Autor: | Steven R. Counsell, Lev Inger, Dawn Butler, Alexia M. Torke, James E. Slaven, Bernard J. Hammes, Susan E. Hickman |
|---|---|
| Rok vydání: | 2018 |
| Předmět: |
Advance care planning
Male Palliative care Inservice Training Health Personnel Decision Making 03 medical and health sciences Advance Care Planning 0302 clinical medicine Hospitals Urban Nursing 030502 gerontology Medicine Humans Aged Aged 80 and over business.industry Racial Groups Patient Preference General Medicine Bioethics Life Support Care Physician patient communication 030220 oncology & carcinogenesis Facilitation Feasibility Studies Female 0305 other medical science business End-of-life care |
| Zdroj: | The American journal of hospicepalliative care. 36(1) |
| ISSN: | 1938-2715 |
| Popis: | Background: The Physician Orders for Life-Sustaining Treatment (POLST) form is an advance care planning tool designed for seriously ill patients. The discussions needed for high-quality POLST decision-making are time intensive and often do not occur in the outpatient setting. Objective: We conducted a single-arm feasibility study of POLST facilitation by nonphysicians using Respecting Choices Last Steps, a standardized, structured approach to facilitation of POLST conversations. Setting/Participants: Community-dwelling adults aged 65 and older enrolled in a complex care management program in a Midwestern urban hospital. Measurements: We assessed the feasibility and acceptability by determining the proportion of eligible patients who enrolled and completed the study, by adherence to the Respecting Choices protocol, and by responses to qualitative and quantitative survey items about the intervention. Results: We enrolled 18 (58.1%) of 31 eligible patients, with a mean age of 77.8 years (standard deviation: 6.95); 12 were African American. The POLST facilitation was delivered to all 18; 10 (55.6%) completed POLST forms. Direct observation of intervention delivery using a checklist found 85% of the required elements were performed by facilitators. We completed 6- to 8-week follow-up interviews in 16 of 18 patients (88.9%). We found 87.5% of decision makers agreed or strongly agreed that “Talking about the (POLST) form helped me think about what I really want.” Conclusions: The POLST facilitation can be successfully delivered to frail older adults in a complex care management setting, with high fidelity to protocol. Further research is needed to demonstrate the effects of this approach on decision quality and other patient-reported outcomes. |
| Databáze: | OpenAIRE |
| Externí odkaz: |
|