Department of Anaesthesiology and Intensive Care, Vejle and Middelfart Hospitals, University Hospital of Southern Denmark, Beriderbakken 4, DK-7100, Vejle, Denmark.
Department of Regional Health Research, University of Southern Denmark, J.B.Winsløwsvej 19, DK-5000, Odense, Denmark.
BMC Palliat Care. 2022 Jan 11;21(1):9. doi: 10.1186/s12904-021-00892-2.
Medically frail and/or chronically ill patients are often admitted to Danish hospitals without documentation of patient preferences. This may lead to inappropriate care. Modelled on the American Physician Orders for Life-Sustaining Treatment (POLST) form, the purpose of the study was to develop and pilot test a Danish POLST form to ensure that patients' preferences for levels of life-sustaining treatment are known and documented.
The study was a mixed methods study. In the initial phase, a Danish POLST form was developed on the basis of literature and recommendations from the National POLST organisation in the US. A pilot test of the Danish POLST form was conducted in hospital wards, general practitioners' clinics, and nursing homes. Patients were eligible for inclusion if death was assessed as likely within 12 months. The patient and his/her physician engaged in a conversation where patient values, beliefs, goals for care, diagnosis, prognosis, and treatment alternatives were discussed. The POLST form was completed based on the patient's values and preferences. Family members and/or nursing staff could participate. Participants' assessments of the POLST form were evaluated using questionnaires, and in-depth interviews were conducted to explore experiences with the POLST form and the conversation.
In total, 25 patients participated, 45 questionnaires were completed and 14 interviews were conducted. Most participants found the POLST form readable and understandable, and 93% found the POLST form usable to a high or very high degree for discussing preferences regarding life-sustaining treatment. Three themes emerged from the interviews: (a) an understandable document is essential for the conversation, (b) handling and discussing wishes, and (c) significance for the future.
The Danish version of the POLST form is assessed by patients, families, physicians, and nurses as a useful model for obtaining and documenting Danish patients' preferences for life-sustaining treatment. However, this needs to be confirmed in a larger-scale study.
体弱多病和/或患有慢性病的患者经常在没有记录患者偏好的情况下被送往丹麦的医院。这可能导致护理不当。该研究以美国的《医生指令维持生命治疗》（POLST）表格为蓝本，旨在开发和试点测试丹麦的 POLST 表格，以确保了解和记录患者对维持生命治疗水平的偏好。
该研究是一项混合方法研究。在初始阶段，根据文献和美国国家 POLST 组织的建议，开发了丹麦的 POLST 表格。在医院病房、全科医生诊所和疗养院进行了丹麦 POLST 表格的试点测试。如果预计患者在 12 个月内死亡，则符合纳入标准。患者及其医生进行了一次对话，讨论了患者的价值观、信仰、护理目标、诊断、预后和治疗选择。根据患者的价值观和偏好填写 POLST 表格。家属和/或护理人员可以参与。使用问卷评估参与者对 POLST 表格的评估，并进行深入访谈，以探讨对 POLST 表格和对话的经验。
共有 25 名患者参与，完成了 45 份问卷，并进行了 14 次访谈。大多数参与者认为 POLST 表格易于阅读和理解，93%的人认为 POLST 表格非常有用，可以用于讨论维持生命治疗的偏好。访谈中出现了三个主题：（a）易懂的文件对于对话至关重要，（b）处理和讨论意愿，以及（c）对未来的意义。
患者、家属、医生和护士评估丹麦版的 POLST 表格是一种有用的模型，可以获取和记录丹麦患者对维持生命治疗的偏好。然而，这需要在更大规模的研究中得到证实。
