Factors associated with concordance between POLST orders and current treatment preferences

Area of Science:

• Gerontology
• Palliative Care
• Health Services Research

Background:

• Physician Orders for Life-Sustaining Treatment (POLST) are utilized in nursing facilities to document resident preferences.
• The concordance between existing POLST orders and current resident preferences is not well understood.
• Factors influencing POLST concordance require investigation.

Purpose of the Study:

• To assess the concordance of POLST orders with current treatment preferences among nursing facility residents.
• To identify factors associated with POLST concordance in this population.

Main Methods:

• A study involving chart reviews of existing POLST orders and resident interviews to determine current preferences.
• Participants included nursing facility residents and surrogates for residents lacking decisional capacity across 29 Indiana facilities.
• Concordance was evaluated by comparing POLST orders for resuscitation, interventions, and nutrition with stated preferences.

Main Results:

• Overall POLST concordance was 44%, with higher rates for comfort-focused POLSTs (68%) compared to non-comfort-focused ones (27%).
• Factors like resident age, cognitive function, and surrogate decision-making were initially associated with concordance.
• Multivariable analysis revealed that only comfort-focused POLSTs were significantly associated with higher concordance (OR 5.28).

Conclusions:

• Less than half of POLST forms accurately reflect current resident preferences.
• POLST is over five times more likely to be concordant when it specifies comfort-focused care.
• There is a critical need to enhance POLST quality and application, particularly for residents with stable, comfort-focused preferences.