Use of the Physician Orders for Life‐Sustaining Treatment Program in Oregon Nursing Facilities: Beyond Resuscitation Status

Hickman, Susan E.; Tolle, Susan W.; Brummel‐Smith, Kenneth; Carley, Margaret

doi:10.1111/j.1532-5415.2004.52402.x

Cited by 108 publications

(99 citation statements)

References 11 publications

(34 reference statements)

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“…41,42 A national registry could incorporate the state models such as Oregon, that have been successful at making DNR orders accessible to EMS providers. 43,44 This will increase the likelihood that a patient's DNR wishes are respected, even in the setting of out-of-the hospital cardiac arrest. 45 Improving physician knowledge of the DNR process 46 should also reduce the burden on family members who are asked to make these decisions under stress or when they are unsure of their family member's wishes.…”

Section: Discussionmentioning

confidence: 99%

A Qualitative Study to Identify Barriers to Local Implementation of Prehospital Termination of Resuscitation Protocols

Sasson

Forman

Krass

et al. 2009

Circ: Cardiovascular Quality and Outcomes

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Background— Despite the existence of national American Heart Association guidelines and 2 termination-of-resuscitation (TOR) rules for ceasing efforts in refractory out-of-hospital cardiac arrest, many emergency medical services agencies in the United States have adopted their own local protocols. Public policies and local perceptions may serve as barriers or facilitators to implementing national TOR guidelines at the local level. Methods and Results— Three focus groups, lasting 90 to 120 minutes, were conducted at the National Association of Emergency Medical Services Physicians meeting in January 2008. Snowball sampling was used to recruit participants. Two reviewers analyzed the data in an iterative process to identify recurrent and unifying themes. We identified 3 distinct groups whose current policies or perceptions may impede efforts to adopt national TOR guidelines: payers who incentivize transport; legislators who create state mandates for transport and allow only narrow use of do-not-resuscitate orders; and communities where cultural norms are perceived to impede termination of resuscitation. Our participants suggested that national organizations, such as the American Heart Association and American College of Emergency Physicians, may serve as potential facilitators in addressing these barriers by taking the lead in asking payers to change reimbursement structures; encouraging legislators to revise laws to reflect the best available medical evidence; and educating the public that rapid transport to the hospital cannot substitute for optimal provision of prehospital care. Conclusion— We have identified 3 influential groups who will need to work with national organizations to overcome current policies or prevailing perceptions that may impede implementing national TOR guidelines.

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Section: Discussionmentioning

confidence: 99%

A Qualitative Study to Identify Barriers to Local Implementation of Prehospital Termination of Resuscitation Protocols

Sasson

Forman

Krass

et al. 2009

Circ: Cardiovascular Quality and Outcomes

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show abstract

“…West Virginia and New York have similar programs under slightly different names, and several more states are developing similar programs. The orders generally address cardiopulmonary resuscitation, hydration, and feeding (36). Hopefully, other interventions such as dialysis would be included by the physician, particularly if ARF could be predicted, such as in patients with pre-existing chronic kidney disease.…”

Section: Preferences Of the Patient Or Proxymentioning

confidence: 99%

Withholding and Withdrawing Dialysis in the Intensive Care Unit

Patel

Holley

2008

Clinical Journal of the American Society of Nephrology

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Despite advances in the technology of dialysis, mortality in patients who develop acute renal failure remains high. Scoring systems have been developed to improve the ability to define prognosis in seriously ill patients with acute renal failure but predicting outcomes for individual patients is uncertain. Decisions to withhold or withdraw dialysis in seriously ill patients are difficult for patients, families, and health care providers. The clinical practice guideline, Shared Decision-Making in the Appropriate Initiation of and Withdrawal from Dialysis, provides evidence-based recommendations to aid nephrologists in discussions and the process of medical decision-making about starting and stopping dialysis. Estimating prognosis and addressing the issues of advance directives and patient and family preferences through the process of shared decision-making can clarify appropriate strategies for clinical management and interventions. Time-limited trials of dialysis may be an invaluable tool in this process. Increasing nephrologists' awareness of the guideline may facilitate decision-making around the issues of withholding and withdrawing dialysis in part by clarifying patients and situations in which it may be appropriate to withhold or withdraw dialysis.

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“…POLST was found to be an effective tool in studies that examined whether treatments provided at the end of life matched the orders on the form, [3][4][5] though far less research has been done to evaluate whether POLSTorders truly reflect patient wishes; this is an important area where further research would be useful. 6 Additionally, the TRIAD (The Realistic Interpretation of Advance Directives) studies showed misunderstandings among various healthcare workers regarding the interpretation of advance directives and related documents.…”

mentioning

confidence: 99%

Experiences with POLST: Opportunities for Improving Advance Care Planning

Braun

2016

J GEN INTERN MED

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Use of the Physician Orders for Life‐Sustaining Treatment Program in Oregon Nursing Facilities: Beyond Resuscitation Status

Abstract: The POLST program is widely used in Oregon nursing facilities. A majority of individuals with DNR orders requested some other form of life-extending treatment, and advanced age was associated with orders to limit treatments.

Cited by 108 publications

References 11 publications

A Qualitative Study to Identify Barriers to Local Implementation of Prehospital Termination of Resuscitation Protocols

A Qualitative Study to Identify Barriers to Local Implementation of Prehospital Termination of Resuscitation Protocols

Withholding and Withdrawing Dialysis in the Intensive Care Unit

Experiences with POLST: Opportunities for Improving Advance Care Planning

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