Department of Community & Health Systems, Indiana University School of Nursing, Indianapolis, Indiana, USA.
Research in Palliative and End-of-Life Communication & Training (RESPECT) Signature Center, Indiana University Purdue University Indianapolis, Indianapolis, Indiana, USA.
J Am Geriatr Soc. 2023 Jul;71(7):2271-2278. doi: 10.1111/jgs.18330. Epub 2023 Mar 16.
POLST orders are actionable in an emergency, so it is important that the decisions be of high quality and concordant with current preferences. The goal of this study is to determine the relationship between concordance and decision quality outcomes, including decision satisfaction and decisional conflict, among nursing facility residents and surrogates who recall POLST.
We completed structured interviews in 29 nursing facilities with 275 participants who had previously signed a POLST form. This included residents who were still making their own medical decisions (n = 123) and surrogate decision-makers for residents without decisional capacity (n = 152). POLST recall was defined as remembering talking about and/or completing the POLST form previously signed by the participant. Concordance was determined by comparing preferences elicited during a standardized interview with the POLST form on file. Decisional conflict, decision satisfaction, and conversation quality were assessed with standardized tools.
Half of participants (50%) remembered talking about or completing the POLST form, but recall was not associated with the length of time since POLST completion or concordance with existing preferences. In multivariable analyses, there was no association between POLST recall, concordance, and decision quality outcomes, though satisfaction was associated with conversation quality.
Half of the residents and surrogates in this study recalled the POLST they previously signed. Neither the age of the form nor the ability to recall the POLST conversation should be considered indicators of whether existing POLST orders match current preferences. Findings confirm a relationship between POLST conversation quality and satisfaction, underscoring the importance of POLST completion as a communication process.
POLST 医嘱在紧急情况下具有可执行性，因此确保决策具有高质量且与当前偏好一致非常重要。本研究的目的是确定在回忆 POLST 的护理院居民和代理人中，一致性与决策质量结果（包括决策满意度和决策冲突）之间的关系。
我们在 29 家护理院完成了 275 名参与者的结构访谈，这些参与者之前都签署过 POLST 表格。其中包括仍在自行做出医疗决策的居民（n=123）和无决策能力的居民的代理人（n=152）。POLST 回忆被定义为参与者回忆起之前曾讨论过并/或完成过 POLST 表格。一致性通过将标准化访谈中得出的偏好与档案中的 POLST 表格进行比较来确定。使用标准化工具评估决策冲突、决策满意度和对话质量。
半数参与者（50%）记得曾讨论过或完成过 POLST 表格，但回忆与 POLST 完成后时间的长短或与现有偏好的一致性无关。在多变量分析中，POLST 回忆、一致性与决策质量结果之间没有关联，尽管满意度与对话质量有关。
本研究中，一半的居民和代理人回忆起他们之前签署的 POLST。表格的年龄或回忆 POLST 对话的能力都不应被视为现有 POLST 医嘱是否符合当前偏好的指标。研究结果证实了 POLST 对话质量与满意度之间的关系，强调了 POLST 完成作为沟通过程的重要性。
