TRIAD VIII: Nationwide Multicenter Evaluation to Determine Whether Patient Video Testimonials Can Safely Help Ensure Appropriate Critical Versus End-of-Life Care

Abstract

For most scenarios, consensus was not attained for code status and resuscitation decisions with stand-alone LW and POLST documents. Adding VMs produced significant impacts toward achieving interpretive consensus.

TRIAD XI: Utilizing simulation to evaluate the living will and POLST ability to achieve goal concordant care when critically ill or at end‐of‐life—The Realistic Interpretation of Advance Directives

“…Previous research (TRIAD VIII) with scripted patient to clinician video (SPCV) and EOL documents has demonstrated statistically significant improvement in understanding EOL documents. The provision of care in the SPCV arm was concordant or achieved statistically significant changes nearing concordance and thus achieving GCC 25 . Furthermore, the legal community is in the process of amending legal requirements and education in preparation for video based advance directives 28 .…”

TRIAD XII: Are Patients Aware of and Agree With DNR or POLST Orders in Their Medical Records

“…8 A more novel approach would be to use scripted patient to clinician video and empower both patients and HCA's to prevent the medical error before it starts. 12,25 With the approval of ACP codes for medical provider reimbursement, there is now an opportunity to formalize the structure of the conversation and to check and verify that the orders are created appropriately and correctly. Because EOL care and critical illness are not always the same, 26 systems nationwide should evaluate their existing policies and procedures to ensure that we capture this vital information to ensure the safety of both the healthy as well as terminally ill patient navigating the system.…”

“…10–13 The POLST forms can be confusing, resulting in patient deaths or overresuscitations. 4,5,12,13 The incomplete POLST forms added further confusion resulting in over resuscitations when at EOL. 14 Despite these shortcomings, several studies have indicated conformance between the POLST form content, patient treatment, and patient outcomes.…”

What’s in a Do-Not-Resuscitate Order? Understanding the Impact on Pre-arrest Life Support and Factors Influencing Misconceptions

“…Some patients elect to avoid CPR, but have preferences for life support they are willing to receive prior to a cardiopulmonary arrest, which can be documented in an out-of-hospital Provider Orders for Life-Sustaining Treatments (POLST) form. 1 The American Medical Association makes a clear statement that code status directs care at the time of cardiopulmonary arrest, and it should not impact life support delivered to a patient who is clinically deteriorating (still has a pulse and is breathing) unless otherwise directed by the patient. 2 While studies have confirmed this association between DNR order status with care a provider would deliver when the patient still has a pulse and is breathing, 3,4 few studies have examined how a provider's discipline, training background, and years of experience influence this bias with code status.…”