To What Extent Do Physician Orders for Life-Sustaining Treatment (POLST) Reflect Patients' Preferences for Care at the End of Life?

Página do item simplificado
dc.contributor.authorLovadini, Gustavo B. [UNESP]
dc.contributor.authorFukushima, Fernanda B. [UNESP]
dc.contributor.authorSchoueri, Joao F.L. [UNESP]
dc.contributor.authorReis, Roberto dos [UNESP]
dc.contributor.authorFonseca, Cecilia G.F. [UNESP]
dc.contributor.authorRodriguez, Jahaira J.C. [UNESP]
dc.contributor.authorCoelho, Cauana S. [UNESP]
dc.contributor.authorNeves, Adriele F. [UNESP]
dc.contributor.authorRodrigues, Aniela M. [UNESP]
dc.contributor.authorMarques, Marina A. [UNESP]
dc.contributor.authorBassett, Rick
dc.contributor.authorSteinberg, Karl E.
dc.contributor.authorMoss, Alvin H.
dc.contributor.authorVidal, Edison I.O. [UNESP]
dc.contributor.institutionUniversidade Estadual Paulista (Unesp)
dc.contributor.institutionSt Luke's Health System
dc.contributor.institutionInstitute for Palliative Care
dc.contributor.institutionWest Virginia University
dc.date.accessioned2021-06-25T10:17:08Z
dc.date.available2021-06-25T10:17:08Z
dc.date.issued2021-02-01
dc.description.abstractObjective: 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.en
dc.description.affiliationBotucatu Medical School Sao Paulo State University (UNESP)
dc.description.affiliationCenter for Nursing Excellence St Luke's Health System
dc.description.affiliationCalifornia State University Institute for Palliative Care
dc.description.affiliationCenter for Health Ethics and Law West Virginia University
dc.description.affiliationUnespBotucatu Medical School Sao Paulo State University (UNESP)
dc.description.sponsorshipFundação de Amparo à Pesquisa do Estado de São Paulo (FAPESP)
dc.description.sponsorshipIdFAPESP: 2014/23966-0
dc.description.sponsorshipIdFAPESP: 2014/23997-3
dc.description.sponsorshipIdFAPESP: 2016/25410-5
dc.format.extent334-339.e2
dc.identifierhttp://dx.doi.org/10.1016/j.jamda.2020.10.016
dc.identifier.citationJournal of the American Medical Directors Association, v. 22, n. 2, p. 334-339.e2, 2021.
dc.identifier.doi10.1016/j.jamda.2020.10.016
dc.identifier.issn1538-9375
dc.identifier.issn1525-8610
dc.identifier.scopus2-s2.0-85096825293
dc.identifier.urihttp://hdl.handle.net/11449/205544
dc.language.isoeng
dc.relation.ispartofJournal of the American Medical Directors Association
dc.sourceScopus
dc.subjectadvance care planning
dc.subjectadvance directives
dc.subjectpalliative care
dc.subjectPOLST
dc.subjectvalidation studies
dc.titleTo What Extent Do Physician Orders for Life-Sustaining Treatment (POLST) Reflect Patients' Preferences for Care at the End of Life?en
dc.typeArtigo
unesp.author.orcid0000-0002-7699-4932[3]
unesp.author.orcid0000-0002-9770-9889[12]
unesp.author.orcid0000-0002-1573-4678[14]

Arquivos

Coleções

Artigos