POLST completion in ElderPlace exceeds reported advance directive rates. Care matched POLST instructions for CPR, antibiotics, IV fluids, and feeding tubes more consistently than previously reported for advance directive instructions. Medical intervention level was consistent with POLST instructions for less than half the participants, however. We conclude that the POLST is effective for limiting the use of some life-sustaining interventions, but that the factors that lead physicians to deviate from patients' stated preferences merit further investigation.

No abstract

Adjectives or phrases used by women in their description of childbirth were identified by interviewing two groups of 10 women, one drawn from an antenatal clinic, the other following delivery of a healthy child. The terms obtained were formed into a questionnaire on which 106 antenatal women described their expectations of childbirth and 82 postnatal women described their experience. Principal components analysis revealed two important findings. First, the ratings were multidimensional; that is, a dimension of fulfillment and achievement was independent of one of emotional feeling. Second, painfulness was not associated with either dimension.

A sample of 15 women was interviewed 18-96 h postnatally to identify objective features of labour and postnatal care about which they expressed preferences. The importance of each item to a mother's satisfaction was then rated by a sample of 224 similar women. The same questionnaire was also completed by 28 midwives and 52 obstctricians. The items rated most important concerned the explanation of procedures and the involvement of mothers in administering or choosing them. Second was support from the presence of a partner and qualified hospital staff, third the physical comfort of the postnatal ward. The avoidance of obstetric interventions, such as episiotoiny or use of forceps, was less important than the presence of these other features. Thc mean ranking given to each item by the midwives and obstetricians correlated very highly with that given by the mothers; those caring for obstetric patients are much more sensitive to their preferences than is popularly believed. There was no evidence that midwives perceived paticnts' necds more accurately than did the obstetricians. Discrepancies between the three groups' ranking of specific items may reflect the defence of their respective roles by each profession. Medicine in general, and obstctries in particular, has become the subjcct of increasingly detailed audit. both h! the providers of the service and the users. In this way reports of women's dislike or resentment of obstetric or midwifery care have accumulated. Many of thcsc reports have

The study did not demonstrate that a single point-in-time measurement of pain in demented persons was associated with an increased rate of behavioral problems, narcotic use, or hospital or emergency department use over the following year. Prospective studies are needed that measure pain over time to determine more accurately the relationship between pain and negative outcomes in dementia.