Botucatu Medical School, Sao Paulo State University (UNESP), Botucatu, Sao Paulo, Brazil.
Center for Nursing Excellence, St Luke's Health System, Boise, ID, USA.
J Am Med Dir Assoc. 2021 Feb;22(2):334-339.e2. doi: 10.1016/j.jamda.2020.10.016. Epub 2020 Nov 13.
To assess whether medical orders within Physician Orders for Life-Sustaining Treatment (POLST) forms reflect patients' preferences for care at the end of life.
This cross-sectional study assessed the agreement between medical orders in POLST forms and the free-form text documentation of an advance care planning conversation performed by an independent researcher during a single episode of hospitalization.
Inpatients at a single public university hospital, aged 21 years or older, and for whom one of their attending physicians provided a negative answer to the following question: "Would I be surprised if this patient died in the next year?" Data collection occurred between October 2016 and September 2017.
Agreement between medical orders in POLST forms and the free-form text documentation of an advance care planning conversation was measured by kappa statistics.
Sixty-two patients were interviewed. Patients' median (interquartile range) age was 62 (56-70) years, and 21 patients (34%) were women. Overall, in 7 (11%) cases, disagreement in at least 1 medical order for life-sustaining treatment was found between POLST forms and the content of the independent advance care planning conversation. The kappa statistic for cardiopulmonary resuscitation was 0.92 [95% confidence interval (CI): 0.82-1.00]; for level of medical intervention, 0.90 (95% CI: 0.81-0.99); and for artificially administered nutrition, 0.87 (95% CI: 0.75-0.98).
The high level of agreement between medical orders in POLST forms and the documentation in an independent advance care planning conversation offers further support for the POLST paradigm. In addition, the finding that the agreement was not 100% underscores the need to confirm frequently that POLST medical orders accurately reflect patients' current values and preferences of care.
评估《医生指令延续生命治疗计划》（POLST）表单中的医疗指令是否反映了患者在生命末期的护理偏好。
本横断面研究评估了 POLST 表单中的医疗指令与独立研究人员在单次住院期间进行的预先护理计划对话的自由文本记录之间的一致性。
单所公立大学医院的住院患者，年龄 21 岁或以上，且其主治医生对以下问题的回答是否定的：“如果这位患者在接下来的一年中去世，我会感到惊讶吗？”数据收集于 2016 年 10 月至 2017 年 9 月进行。
通过kappa 统计评估 POLST 表单中的医疗指令与预先护理计划对话的自由文本记录之间的一致性。
共对 62 名患者进行了访谈。患者的中位（四分位距）年龄为 62（56-70）岁，21 名患者（34%）为女性。总体而言，在 7（11%）例患者中，POLST 表单和独立预先护理计划对话的内容在至少 1 项生命支持治疗的医疗指令上存在不一致。心肺复苏的kappa 统计值为 0.92[95%置信区间（CI）：0.82-1.00]；医疗干预水平的kappa 统计值为 0.90（95% CI：0.81-0.99）；人工营养支持的 kappa 统计值为 0.87（95% CI：0.75-0.98）。
POLST 表单中的医疗指令与独立预先护理计划对话的记录之间高度一致，进一步支持了 POLST 模式。此外，发现一致性并非 100%，这强调了需要经常确认 POLST 医疗指令是否准确反映患者当前的护理价值和偏好。
