POLST Facilitation in Complex Care Management: A Feasibility Study

Area of Science:

• Gerontology
• Health Services Research
• Palliative Care

Background:

• Physician Orders for Life-Sustaining Treatment (POLST) forms are crucial for advance care planning in seriously ill patients.
• High-quality POLST discussions are time-intensive and challenging to conduct in outpatient settings.

Purpose of the Study:

• To assess the feasibility and acceptability of nonphysician-led POLST facilitation using a standardized approach.
• To evaluate the delivery of POLST conversations within a complex care management program.

Main Methods:

• A single-arm feasibility study involving community-dwelling adults aged 65+ in a Midwestern urban hospital's complex care program.
• Feasibility and acceptability were measured by enrollment rates, completion rates, adherence to the Respecting Choices protocol, and participant surveys.
• Intervention delivery was observed using a checklist, and follow-up interviews were conducted.

Main Results:

• 18 of 31 eligible patients (58.1%) enrolled; 10 (55.6%) completed POLST forms.
• Facilitators adhered to 85% of the protocol elements during POLST conversations.
• 88.9% of patients completed follow-up interviews, with 87.5% agreeing that discussions helped clarify their wishes.

Conclusions:

• Nonphysician facilitation of POLST is feasible and can be delivered with high fidelity to frail older adults in complex care settings.
• This approach demonstrates potential for improving advance care planning discussions.
• Further research is warranted to explore the impact on decision quality and patient-reported outcomes.