Palliative Medicine and Decision Science: The Critical Need for a Shared Agenda To Foster Informed Patient Choice in Serious Illness

Bakitas, Marie; Kryworuchko, Jennifer; Matlock, Daniel D.; Volandes, Angelo E.

doi:10.1089/jpm.2011.0032

Cited by 55 publications

(70 citation statements)

References 60 publications

Supporting

Mentioning

Contrasting

Unclassified

Order By: Relevance

“…Research focused on the quality of decisions at the end of life has been identified as a national priority in both the fields of decision science and palliative medicine 25 and represents an important next step in evaluating the POLST program. 15 The findings from this pilot study suggest that better tools and methods are needed to assess the quality of POLST decisions and POLST conversations.…”

Section: Directions For Future Researchmentioning

confidence: 99%

Use of the Physician Orders for Life-Sustaining Treatment Program for Patients Being Discharged from the Hospital to the Nursing Facility

Hickman

Nelson

Smith-Howell

et al. 2014

Journal of Palliative Medicine

View full text Add to dashboard Cite

Background: The Physician Orders for Life-Sustaining Treatment (POLST) documents patient preferences as medical orders that transfer across settings with patients. Objectives: The objectives were to pilot test methods and gather preliminary data about POLST including (1) use at time of hospital discharge, (2) transfers across settings, and (3) consistency with prior decisions. Study Design: Descriptive with chart abstraction and interviews. Participants: Participants were hospitalized patients discharged to a nursing facility and/or their surrogates in La Crosse County, Wisconsin. Measurements: POLST forms were abstracted from hospital records for 151 patients. Hospital and nursing facility chart data were abstracted and interviews were conducted with an additional 39 patients/surrogates. Results: Overall, 176 patients had valid POLST forms at the time of discharge from the hospital, and many (38.6%; 68/176) only documented code status. When the whole POLST was completed, orders were more often marked as based on a discussion with the patient and/or surrogate than when the form was used just for code status (95.1% versus 13.8%, p < .001). In the follow-up and interview sample, a majority (90.6%; 29/32) of POLST forms written in the hospital were unchanged up to three weeks after nursing facility admission. Most (71.9%; 23/32) appeared consistent with patient or surrogate recall of prior treatment decisions. Conclusion: POLST forms generated in the hospital do transfer with patients across settings, but are often used only to document code status. POLST orders appeared largely consistent with prior treatment decisions. Further research is needed to assess the quality of POLST decisions.

show abstract

Section: Directions For Future Researchmentioning

confidence: 99%

Use of the Physician Orders for Life-Sustaining Treatment Program for Patients Being Discharged from the Hospital to the Nursing Facility

Hickman

Nelson

Smith-Howell

et al. 2014

Journal of Palliative Medicine

View full text Add to dashboard Cite

show abstract

“…Initially, 79% of residents and 50% of surrogates expressed preferences that appeared discrepant with existing POLST orders [v 2 (1, n = 28) = 2.5, p = 0.24]. Participant explanations for the apparent discrepancies included a lack of knowledge, a lack of clarity concerning preferences, initial confusion about what was being discussed, and a lack of interest in the decisions.…”

Section: Characteristics Of the Polst Conversationmentioning

confidence: 99%

“…As a result, the best choice is heavily dependent on patient preferences rather than clinical considerations. 2,3 The generally accepted best practice is to discuss and document end-of-life treatment preferences well in advance of the need for treatment due to concerns that patients will be unable to participate in decision making about critical decisions when the time comes. This can result in a gap of weeks, months, or even years between the discussion and when an advance care plan is acted upon.…”

mentioning

confidence: 99%

The Quality of Physician Orders for Life-Sustaining Treatment Decisions: A Pilot Study

Hickman

Hammes

Torke

et al. 2017

Journal of Palliative Medicine

View full text Add to dashboard Cite

Background: Physician Orders for Life-Sustaining Treatment (POLST) forms are used to document patient treatment preferences as medical orders. Prior research demonstrates that use of POLST alters medical treatments in a way that is consistent with the POLST orders. However, there are minimal data about the quality of POLST decisions, including whether they reflect the current preferences of well-informed patients. Objective: Evaluate the quality of POLST decisions. Design: Chart abstraction; interviews. Subjects: Nursing home residents and healthcare agents of incapacitated nursing home residents (n = 28). Measurements: Characteristics of the POLST conversation were assessed. Brief vignettes were used to assess knowledge about how POLST orders guide medical treatment. Current treatment preferences were elicited and compared with the patient's POLST orders to assess discordance. Results: A majority (59%) of participants recognized the POLST form. Participants were generally accurate in their knowledge of how POLST orders guide treatment concerning cardiopulmonary resuscitation (CPR) (68%), antibiotics (74%), and artificial nutrition (79%), but less so for medical interventions (50%). Current treatment preferences were initially discordant with one or more POLST orders for 64% (18/28) of participants, but half of these discordances were resolved with further discussion (e.g., participant agreed with the existing order). Discordance by treatment decision was as follows: CPR (7%), level of medical intervention (18%), antibiotics (21%), and artificial nutrition (11%). Conclusions: Discordance between current preferences and POLST orders is complex. Interventions are needed to support high-quality POLST decisions that are informed and concordant with current preferences.

show abstract

“…These include, but are not limited to, decisions Align treatment plans and quality metrics to optimize patient-important goals and preferences to maximize patient quality of life Encourage regulatory and practice changes to allow for greater flexibility in the timing and prescription of dialysis and the development of strong positive treatment alternatives to dialysis Promote regulatory changes for greater integration of hospice and palliative care into other aspects of the care of patients with advanced kidney disease as needed to support patient goals and preferences Increase palliative care training, both in nephrology fellowship programs and continuing medical education about dialysis initiation, continuation, and discontinuation and may also pertain to related interventions (e.g., treatment modality for advanced kidney disease, choice and timing of vascular access placement, referral for kidney transplant) as well as broader efforts to maintain health (e.g., renoprotective and cardioprotective interventions). The emerging field of decision science and associated tools (e.g., decision aids) may be extremely helpful in supporting many of these decisions (56).…”

Section: The Csckp's Vision For the Medicare Esrd Programmentioning

confidence: 99%

Patient-Centered Care

O’Hare

Armistead²,

Schrag

et al. 2014

Clinical Journal of the American Society of Nephrology

View full text Add to dashboard Cite

In light of mounting federal government debt and levels of Medicare spending that are widely viewed as unsustainable, commentators have called for a transformation of the United States health care system to deliver better care at lower costs. This article presents the priorities of the Coalition for Supportive Care of Kidney Patients for how clinicians might achieve this transformation for patients with advanced CKD and their families. The authors suspect that much of the high-intensity, high-cost care currently delivered to patients with advanced kidney disease may be unwanted and that the "Three Aims" put forth by the National Quality Strategy of better care for the individual, better health for populations, and reduced health care costs may be within reach for patients with CKD and ESRD. This work describes the coalition's vision for a more patient-centered approach to the care of patients with kidney disease and argues for more concerted efforts to align their treatments with their goals, values, and preferences. Key priorities to achieve this vision include using improved prognostic models and decision science to help patients, their families, and their providers better understand what to expect in the future; engaging patients and their families in shared decision-making before the initiation of dialysis and during the course of dialysis treatment; and tailoring treatment strategies throughout the continuum of their care to address what matters most to individual patients.

show abstract

Palliative Medicine and Decision Science: The Critical Need for a Shared Agenda To Foster Informed Patient Choice in Serious Illness

Cited by 55 publications

References 60 publications

Use of the Physician Orders for Life-Sustaining Treatment Program for Patients Being Discharged from the Hospital to the Nursing Facility

Use of the Physician Orders for Life-Sustaining Treatment Program for Patients Being Discharged from the Hospital to the Nursing Facility

The Quality of Physician Orders for Life-Sustaining Treatment Decisions: A Pilot Study

Patient-Centered Care

Contact Info

Product

Resources

About