To What Extent Do Physician Orders for Life-Sustaining Treatment (POLST) Reflect Patients' Preferences for Care at the End of Life?
Autor(a) principal: | |
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Data de Publicação: | 2021 |
Outros Autores: | , , , , , , , , , , , , |
Tipo de documento: | Artigo |
Idioma: | eng |
Título da fonte: | Repositório Institucional da UNESP |
Texto Completo: | http://dx.doi.org/10.1016/j.jamda.2020.10.016 http://hdl.handle.net/11449/205544 |
Resumo: | Objective: To assess whether medical orders within Physician Orders for Life-Sustaining Treatment (POLST) forms reflect patients' preferences for care at the end of life. Design: This cross-sectional study assessed the agreement between medical orders in POLST forms and the free-form text documentation of an advance care planning conversation performed by an independent researcher during a single episode of hospitalization. Setting and Participants: Inpatients at a single public university hospital, aged 21 years or older, and for whom one of their attending physicians provided a negative answer to the following question: “Would I be surprised if this patient died in the next year?” Data collection occurred between October 2016 and September 2017. Measures: Agreement between medical orders in POLST forms and the free-form text documentation of an advance care planning conversation was measured by kappa statistics. Results: Sixty-two patients were interviewed. Patients' median (interquartile range) age was 62 (56-70) years, and 21 patients (34%) were women. Overall, in 7 (11%) cases, disagreement in at least 1 medical order for life-sustaining treatment was found between POLST forms and the content of the independent advance care planning conversation. The kappa statistic for cardiopulmonary resuscitation was 0.92 [95% confidence interval (CI): 0.82-1.00]; for level of medical intervention, 0.90 (95% CI: 0.81-0.99); and for artificially administered nutrition, 0.87 (95% CI: 0.75-0.98). Conclusions and Implications: The high level of agreement between medical orders in POLST forms and the documentation in an independent advance care planning conversation offers further support for the POLST paradigm. In addition, the finding that the agreement was not 100% underscores the need to confirm frequently that POLST medical orders accurately reflect patients' current values and preferences of care. |
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To What Extent Do Physician Orders for Life-Sustaining Treatment (POLST) Reflect Patients' Preferences for Care at the End of Life?advance care planningadvance directivespalliative carePOLSTvalidation studiesObjective: To assess whether medical orders within Physician Orders for Life-Sustaining Treatment (POLST) forms reflect patients' preferences for care at the end of life. Design: This cross-sectional study assessed the agreement between medical orders in POLST forms and the free-form text documentation of an advance care planning conversation performed by an independent researcher during a single episode of hospitalization. Setting and Participants: Inpatients at a single public university hospital, aged 21 years or older, and for whom one of their attending physicians provided a negative answer to the following question: “Would I be surprised if this patient died in the next year?” Data collection occurred between October 2016 and September 2017. Measures: Agreement between medical orders in POLST forms and the free-form text documentation of an advance care planning conversation was measured by kappa statistics. Results: Sixty-two patients were interviewed. Patients' median (interquartile range) age was 62 (56-70) years, and 21 patients (34%) were women. Overall, in 7 (11%) cases, disagreement in at least 1 medical order for life-sustaining treatment was found between POLST forms and the content of the independent advance care planning conversation. The kappa statistic for cardiopulmonary resuscitation was 0.92 [95% confidence interval (CI): 0.82-1.00]; for level of medical intervention, 0.90 (95% CI: 0.81-0.99); and for artificially administered nutrition, 0.87 (95% CI: 0.75-0.98). Conclusions and Implications: The high level of agreement between medical orders in POLST forms and the documentation in an independent advance care planning conversation offers further support for the POLST paradigm. In addition, the finding that the agreement was not 100% underscores the need to confirm frequently that POLST medical orders accurately reflect patients' current values and preferences of care.Fundação de Amparo à Pesquisa do Estado de São Paulo (FAPESP)Botucatu Medical School Sao Paulo State University (UNESP)Center for Nursing Excellence St Luke's Health SystemCalifornia State University Institute for Palliative CareCenter for Health Ethics and Law West Virginia UniversityBotucatu Medical School Sao Paulo State University (UNESP)FAPESP: 2014/23966-0FAPESP: 2014/23997-3FAPESP: 2016/25410-5Universidade Estadual Paulista (Unesp)St Luke's Health SystemInstitute for Palliative CareWest Virginia UniversityLovadini, Gustavo B. [UNESP]Fukushima, Fernanda B. [UNESP]Schoueri, Joao F.L. [UNESP]Reis, Roberto dos [UNESP]Fonseca, Cecilia G.F. [UNESP]Rodriguez, Jahaira J.C. [UNESP]Coelho, Cauana S. [UNESP]Neves, Adriele F. [UNESP]Rodrigues, Aniela M. [UNESP]Marques, Marina A. [UNESP]Bassett, RickSteinberg, Karl E.Moss, Alvin H.Vidal, Edison I.O. [UNESP]2021-06-25T10:17:08Z2021-06-25T10:17:08Z2021-02-01info:eu-repo/semantics/publishedVersioninfo:eu-repo/semantics/article334-339.e2http://dx.doi.org/10.1016/j.jamda.2020.10.016Journal of the American Medical Directors Association, v. 22, n. 2, p. 334-339.e2, 2021.1538-93751525-8610http://hdl.handle.net/11449/20554410.1016/j.jamda.2020.10.0162-s2.0-85096825293Scopusreponame:Repositório Institucional da UNESPinstname:Universidade Estadual Paulista (UNESP)instacron:UNESPengJournal of the American Medical Directors Associationinfo:eu-repo/semantics/openAccess2021-10-23T14:48:18Zoai:repositorio.unesp.br:11449/205544Repositório InstitucionalPUBhttp://repositorio.unesp.br/oai/requestopendoar:29462024-08-05T17:22:33.824569Repositório Institucional da UNESP - Universidade Estadual Paulista (UNESP)false |
dc.title.none.fl_str_mv |
To What Extent Do Physician Orders for Life-Sustaining Treatment (POLST) Reflect Patients' Preferences for Care at the End of Life? |
title |
To What Extent Do Physician Orders for Life-Sustaining Treatment (POLST) Reflect Patients' Preferences for Care at the End of Life? |
spellingShingle |
To What Extent Do Physician Orders for Life-Sustaining Treatment (POLST) Reflect Patients' Preferences for Care at the End of Life? Lovadini, Gustavo B. [UNESP] advance care planning advance directives palliative care POLST validation studies |
title_short |
To What Extent Do Physician Orders for Life-Sustaining Treatment (POLST) Reflect Patients' Preferences for Care at the End of Life? |
title_full |
To What Extent Do Physician Orders for Life-Sustaining Treatment (POLST) Reflect Patients' Preferences for Care at the End of Life? |
title_fullStr |
To What Extent Do Physician Orders for Life-Sustaining Treatment (POLST) Reflect Patients' Preferences for Care at the End of Life? |
title_full_unstemmed |
To What Extent Do Physician Orders for Life-Sustaining Treatment (POLST) Reflect Patients' Preferences for Care at the End of Life? |
title_sort |
To What Extent Do Physician Orders for Life-Sustaining Treatment (POLST) Reflect Patients' Preferences for Care at the End of Life? |
author |
Lovadini, Gustavo B. [UNESP] |
author_facet |
Lovadini, Gustavo B. [UNESP] Fukushima, Fernanda B. [UNESP] Schoueri, Joao F.L. [UNESP] Reis, Roberto dos [UNESP] Fonseca, Cecilia G.F. [UNESP] Rodriguez, Jahaira J.C. [UNESP] Coelho, Cauana S. [UNESP] Neves, Adriele F. [UNESP] Rodrigues, Aniela M. [UNESP] Marques, Marina A. [UNESP] Bassett, Rick Steinberg, Karl E. Moss, Alvin H. Vidal, Edison I.O. [UNESP] |
author_role |
author |
author2 |
Fukushima, Fernanda B. [UNESP] Schoueri, Joao F.L. [UNESP] Reis, Roberto dos [UNESP] Fonseca, Cecilia G.F. [UNESP] Rodriguez, Jahaira J.C. [UNESP] Coelho, Cauana S. [UNESP] Neves, Adriele F. [UNESP] Rodrigues, Aniela M. [UNESP] Marques, Marina A. [UNESP] Bassett, Rick Steinberg, Karl E. Moss, Alvin H. Vidal, Edison I.O. [UNESP] |
author2_role |
author author author author author author author author author author author author author |
dc.contributor.none.fl_str_mv |
Universidade Estadual Paulista (Unesp) St Luke's Health System Institute for Palliative Care West Virginia University |
dc.contributor.author.fl_str_mv |
Lovadini, Gustavo B. [UNESP] Fukushima, Fernanda B. [UNESP] Schoueri, Joao F.L. [UNESP] Reis, Roberto dos [UNESP] Fonseca, Cecilia G.F. [UNESP] Rodriguez, Jahaira J.C. [UNESP] Coelho, Cauana S. [UNESP] Neves, Adriele F. [UNESP] Rodrigues, Aniela M. [UNESP] Marques, Marina A. [UNESP] Bassett, Rick Steinberg, Karl E. Moss, Alvin H. Vidal, Edison I.O. [UNESP] |
dc.subject.por.fl_str_mv |
advance care planning advance directives palliative care POLST validation studies |
topic |
advance care planning advance directives palliative care POLST validation studies |
description |
Objective: To assess whether medical orders within Physician Orders for Life-Sustaining Treatment (POLST) forms reflect patients' preferences for care at the end of life. Design: This cross-sectional study assessed the agreement between medical orders in POLST forms and the free-form text documentation of an advance care planning conversation performed by an independent researcher during a single episode of hospitalization. Setting and Participants: Inpatients at a single public university hospital, aged 21 years or older, and for whom one of their attending physicians provided a negative answer to the following question: “Would I be surprised if this patient died in the next year?” Data collection occurred between October 2016 and September 2017. Measures: Agreement between medical orders in POLST forms and the free-form text documentation of an advance care planning conversation was measured by kappa statistics. Results: Sixty-two patients were interviewed. Patients' median (interquartile range) age was 62 (56-70) years, and 21 patients (34%) were women. Overall, in 7 (11%) cases, disagreement in at least 1 medical order for life-sustaining treatment was found between POLST forms and the content of the independent advance care planning conversation. The kappa statistic for cardiopulmonary resuscitation was 0.92 [95% confidence interval (CI): 0.82-1.00]; for level of medical intervention, 0.90 (95% CI: 0.81-0.99); and for artificially administered nutrition, 0.87 (95% CI: 0.75-0.98). Conclusions and Implications: The high level of agreement between medical orders in POLST forms and the documentation in an independent advance care planning conversation offers further support for the POLST paradigm. In addition, the finding that the agreement was not 100% underscores the need to confirm frequently that POLST medical orders accurately reflect patients' current values and preferences of care. |
publishDate |
2021 |
dc.date.none.fl_str_mv |
2021-06-25T10:17:08Z 2021-06-25T10:17:08Z 2021-02-01 |
dc.type.status.fl_str_mv |
info:eu-repo/semantics/publishedVersion |
dc.type.driver.fl_str_mv |
info:eu-repo/semantics/article |
format |
article |
status_str |
publishedVersion |
dc.identifier.uri.fl_str_mv |
http://dx.doi.org/10.1016/j.jamda.2020.10.016 Journal of the American Medical Directors Association, v. 22, n. 2, p. 334-339.e2, 2021. 1538-9375 1525-8610 http://hdl.handle.net/11449/205544 10.1016/j.jamda.2020.10.016 2-s2.0-85096825293 |
url |
http://dx.doi.org/10.1016/j.jamda.2020.10.016 http://hdl.handle.net/11449/205544 |
identifier_str_mv |
Journal of the American Medical Directors Association, v. 22, n. 2, p. 334-339.e2, 2021. 1538-9375 1525-8610 10.1016/j.jamda.2020.10.016 2-s2.0-85096825293 |
dc.language.iso.fl_str_mv |
eng |
language |
eng |
dc.relation.none.fl_str_mv |
Journal of the American Medical Directors Association |
dc.rights.driver.fl_str_mv |
info:eu-repo/semantics/openAccess |
eu_rights_str_mv |
openAccess |
dc.format.none.fl_str_mv |
334-339.e2 |
dc.source.none.fl_str_mv |
Scopus reponame:Repositório Institucional da UNESP instname:Universidade Estadual Paulista (UNESP) instacron:UNESP |
instname_str |
Universidade Estadual Paulista (UNESP) |
instacron_str |
UNESP |
institution |
UNESP |
reponame_str |
Repositório Institucional da UNESP |
collection |
Repositório Institucional da UNESP |
repository.name.fl_str_mv |
Repositório Institucional da UNESP - Universidade Estadual Paulista (UNESP) |
repository.mail.fl_str_mv |
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1808128800889765888 |