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POLST Facilitation in Complex Care Management: A Feasibility Study.

Alexia M Torke1,2,3,4, Susan E Hickman3,4,5, Bernard Hammes6

  • 11 Center for Aging Research, Regenstrief Institute, Inc, Indiana University, Indianapolis, IN, USA.

The American Journal of Hospice & Palliative Care
|August 30, 2018
PubMed
Summary
This summary is machine-generated.

Nonphysician facilitators successfully implemented Physician Orders for Life-Sustaining Treatment (POLST) conversations with older adults in complex care. This approach shows promise for improving advance care planning for seriously ill patients.

Keywords:
advance directivesbioethicsend-of-life careethicspalliative carephysician–patient communication

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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.