Reasons for discordance and concordance between POLST orders and current treatment preferences
| Autor: | Hickman, Susan E, Torke, Alexia M, Heim Smith, Nicholette, Myers, Anne L, Sudore, Rebecca L, Hammes, Bernard J, Sachs, Greg A |
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| Rok vydání: | 2021 |
| Předmět: |
Male
Indiana Advance Directive Adherence palliative care Communication Patient Preference Documentation Basic Behavioral and Social Science Medical and Health Sciences Nursing Homes Advance Care Planning nursing home Geriatrics Behavioral and Social Science 80 and over Humans Homes for the Aged Female Generic health relevance Patient Comfort Qualitative Research Aged |
| Zdroj: | Journal of the American Geriatrics Society, vol 69, iss 7 |
| Popis: | BackgroundThe 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.DesignQualitative descriptive including constant comparative analysis within and across cases.SettingTwenty-six nursing facilities in Indiana.ParticipantsResidents (n= 36) and surrogate decision-makers of residents without decisional capacity (n= 37).MeasurementsA semi-structured interview guide was used to explore the reasons for discordance or concordance between current preferences and existing POLST forms.FindingsReasons 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.ConclusionParticipant 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. |
| Databáze: | OpenAIRE |
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