Journal article
Are We Getting What We Really Want? A Systematic Review of Concordance Between Physician Orders for Life-Sustaining Treatment (POLST) Documentation and Subsequent Care Delivered at End-of-Life
American journal of hospice & palliative medicine, Vol.38(9), pp.1142-1158
09/01/2021
DOI: 10.1177/1049909120976319
PMID: 33251826
Abstract
Background:
Physician Orders for Life-Sustaining Treatments (POLST) is an advance care planning (ACP) tool that is designed to facilitate End-of-Life (EoL) care discussions between a medical provider and a terminally ill patient. It is often used as a tool to translate care wishes into a medical order, which can be honored across healthcare settings. With an increased utilization of the POLST paradigm in various healthcare settings along with continued dissemination across the nation, it is critical to examine whether documented wishes on POLST are concordant with subsequent care delivered. Purpose of this article was to examine concordance rate between POLST and subsequent care delivered in any care settings and communities.
Design:
Systematic review.
Results:
Of 1,406 articles identified, 10 articles met inclusion criteria. Together, included studies represent 5,688 POLST forms reviewed from individuals residing in a total of 126 nursing care facilities, 9 elderly care centers, 4 community settings, and 2 hospitals. Preference for cardiopulmonary resuscitation and actual delivery/ withholding of resuscitation was the most observed intervention in study of concordance (n = 8). It is also where highest concordance rate (97.5%) was reported. Seven studies compared care provided during EoL and the level of medical intervention requested on POLST forms (91.17% concordance). Preference to use artificial nutrition/ hydration, and actual delivery was 93.0% (n = 4 studies), and antibiotics use preference and delivery was 96.5% (reported in 4 studies).
Conclusion:
Published literature evidence suggests that EoL care wishes documented on POLST forms were largely concordant with subsequent care delivered. Additional research is needed to evaluate concordance between POLST documentation and care received among POLST users, who experienced multiple care transitions across healthcare settings, or across state during EoL care journey.
Details
- Title: Subtitle
- Are We Getting What We Really Want? A Systematic Review of Concordance Between Physician Orders for Life-Sustaining Treatment (POLST) Documentation and Subsequent Care Delivered at End-of-Life
- Creators
- Aluem Tark - University of IowaJiyoun Song - Columbia UniversityJyotsana Parajuli - University of North Carolina at CharlotteSena Chae - University of IowaPatricia W. Stone - Columbia University
- Resource Type
- Journal article
- Publication Details
- American journal of hospice & palliative medicine, Vol.38(9), pp.1142-1158
- Publisher
- Sage
- DOI
- 10.1177/1049909120976319
- PMID
- 33251826
- ISSN
- 1049-9091
- eISSN
- 1938-2715
- Number of pages
- 17
- Grant note
- NR011147 / Pain and Associated Symptoms Research Fellowship (NINR) T32NR014205 / Comparative and Cost-Effectiveness Research Training for Nurse Scientists (CER2) (NINR) P20NR018072-01 / Center for Improving Palliative Care for Vulnerable Adults with MCC (CIPC) National Institute of Nursing Research Grant (NINR) GRANT
- Language
- English
- Date published
- 09/01/2021
- Academic Unit
- Nursing
- Record Identifier
- 9984368082502771
Metrics
19 Record Views