A comparison of methods to communicate treatment preferences in nursing facilities: Traditional practices versus the physician orders for life-sustaining treatment program

Susan Hickman, Christine A. Nelson, Nancy A. Perrin, Alvin H. Moss, Bernard J. Hammes, Susan W. Tolle

Research output: Contribution to journalArticle

123 Citations (Scopus)

Abstract

OBJECTIVES: To evaluate the relationship between two methods to communicate treatment preferences (Physician Orders for Life-Sustaining Treatment (POLST) program vs traditional practices) and documentation of life-sustaining treatment orders, symptom assessment and management, and use of life-sustaining treatments. DESIGN: Retrospective observational cohort study conducted between June 2006 and April 2007. SETTING: A stratified, random sample of 90 Medicaid-eligible nursing facilities in Oregon, Wisconsin, and West Virginia. PARTICIPANTS: One thousand seven hundred eleven living and deceased nursing facility residents aged 65 and older with a minimum 60-day stay. MEASUREMENTS: Life-sustaining treatment orders; pain, shortness of breath, and related treatments over a 7-day period; and use of life-sustaining treatments over a 60-day period. RESULTS: Residents with POLST forms were more likely to have orders about life-sustaining treatment preferences beyond cardiopulmonary resuscitation than residents without (98.0% vs 16.1%, P<.001). There were no differences between residents with and without POLST forms in symptom assessment or management. Residents with POLST forms indicating orders for comfort measures only were less likely to receive medical interventions (e.g., hospitalization) than residents with POLST full treatment orders (P=.004), residents with traditional do-not-resuscitate orders (P<.001), or residents with traditional full code orders (P<.001). CONCLUSION: Residents with POLST forms were more likely to have treatment preferences documented as medical orders than those who did not, but there were no differences in symptom management or assessment. POLST orders restricting medical interventions were associated with less use of life-sustaining treatments. Findings suggest that the POLST program offers significant advantages over traditional methods to communicate preferences about life-sustaining treatments.

Original languageEnglish
Pages (from-to)1241-1248
Number of pages8
JournalJournal of the American Geriatrics Society
Volume58
Issue number7
DOIs
StatePublished - Jul 2010

Fingerprint

Nursing
Physicians
Therapeutics
Symptom Assessment
Resuscitation Orders
Cardiopulmonary Resuscitation
Medicaid
Documentation
Dyspnea
Observational Studies
Hospitalization
Cohort Studies

Keywords

  • do not hospitalize
  • do not resuscitate
  • end-of-life
  • ethics
  • nursing facility

ASJC Scopus subject areas

  • Geriatrics and Gerontology

Cite this

A comparison of methods to communicate treatment preferences in nursing facilities : Traditional practices versus the physician orders for life-sustaining treatment program. / Hickman, Susan; Nelson, Christine A.; Perrin, Nancy A.; Moss, Alvin H.; Hammes, Bernard J.; Tolle, Susan W.

In: Journal of the American Geriatrics Society, Vol. 58, No. 7, 07.2010, p. 1241-1248.

Research output: Contribution to journalArticle

@article{a1afb729efbc4c03b62aac0f9c7079d9,
title = "A comparison of methods to communicate treatment preferences in nursing facilities: Traditional practices versus the physician orders for life-sustaining treatment program",
abstract = "OBJECTIVES: To evaluate the relationship between two methods to communicate treatment preferences (Physician Orders for Life-Sustaining Treatment (POLST) program vs traditional practices) and documentation of life-sustaining treatment orders, symptom assessment and management, and use of life-sustaining treatments. DESIGN: Retrospective observational cohort study conducted between June 2006 and April 2007. SETTING: A stratified, random sample of 90 Medicaid-eligible nursing facilities in Oregon, Wisconsin, and West Virginia. PARTICIPANTS: One thousand seven hundred eleven living and deceased nursing facility residents aged 65 and older with a minimum 60-day stay. MEASUREMENTS: Life-sustaining treatment orders; pain, shortness of breath, and related treatments over a 7-day period; and use of life-sustaining treatments over a 60-day period. RESULTS: Residents with POLST forms were more likely to have orders about life-sustaining treatment preferences beyond cardiopulmonary resuscitation than residents without (98.0{\%} vs 16.1{\%}, P<.001). There were no differences between residents with and without POLST forms in symptom assessment or management. Residents with POLST forms indicating orders for comfort measures only were less likely to receive medical interventions (e.g., hospitalization) than residents with POLST full treatment orders (P=.004), residents with traditional do-not-resuscitate orders (P<.001), or residents with traditional full code orders (P<.001). CONCLUSION: Residents with POLST forms were more likely to have treatment preferences documented as medical orders than those who did not, but there were no differences in symptom management or assessment. POLST orders restricting medical interventions were associated with less use of life-sustaining treatments. Findings suggest that the POLST program offers significant advantages over traditional methods to communicate preferences about life-sustaining treatments.",
keywords = "do not hospitalize, do not resuscitate, end-of-life, ethics, nursing facility",
author = "Susan Hickman and Nelson, {Christine A.} and Perrin, {Nancy A.} and Moss, {Alvin H.} and Hammes, {Bernard J.} and Tolle, {Susan W.}",
year = "2010",
month = "7",
doi = "10.1111/j.1532-5415.2010.02955.x",
language = "English",
volume = "58",
pages = "1241--1248",
journal = "Journal of the American Geriatrics Society",
issn = "0002-8614",
publisher = "Wiley-Blackwell",
number = "7",

}

TY - JOUR

T1 - A comparison of methods to communicate treatment preferences in nursing facilities

T2 - Traditional practices versus the physician orders for life-sustaining treatment program

AU - Hickman, Susan

AU - Nelson, Christine A.

AU - Perrin, Nancy A.

AU - Moss, Alvin H.

AU - Hammes, Bernard J.

AU - Tolle, Susan W.

PY - 2010/7

Y1 - 2010/7

N2 - OBJECTIVES: To evaluate the relationship between two methods to communicate treatment preferences (Physician Orders for Life-Sustaining Treatment (POLST) program vs traditional practices) and documentation of life-sustaining treatment orders, symptom assessment and management, and use of life-sustaining treatments. DESIGN: Retrospective observational cohort study conducted between June 2006 and April 2007. SETTING: A stratified, random sample of 90 Medicaid-eligible nursing facilities in Oregon, Wisconsin, and West Virginia. PARTICIPANTS: One thousand seven hundred eleven living and deceased nursing facility residents aged 65 and older with a minimum 60-day stay. MEASUREMENTS: Life-sustaining treatment orders; pain, shortness of breath, and related treatments over a 7-day period; and use of life-sustaining treatments over a 60-day period. RESULTS: Residents with POLST forms were more likely to have orders about life-sustaining treatment preferences beyond cardiopulmonary resuscitation than residents without (98.0% vs 16.1%, P<.001). There were no differences between residents with and without POLST forms in symptom assessment or management. Residents with POLST forms indicating orders for comfort measures only were less likely to receive medical interventions (e.g., hospitalization) than residents with POLST full treatment orders (P=.004), residents with traditional do-not-resuscitate orders (P<.001), or residents with traditional full code orders (P<.001). CONCLUSION: Residents with POLST forms were more likely to have treatment preferences documented as medical orders than those who did not, but there were no differences in symptom management or assessment. POLST orders restricting medical interventions were associated with less use of life-sustaining treatments. Findings suggest that the POLST program offers significant advantages over traditional methods to communicate preferences about life-sustaining treatments.

AB - OBJECTIVES: To evaluate the relationship between two methods to communicate treatment preferences (Physician Orders for Life-Sustaining Treatment (POLST) program vs traditional practices) and documentation of life-sustaining treatment orders, symptom assessment and management, and use of life-sustaining treatments. DESIGN: Retrospective observational cohort study conducted between June 2006 and April 2007. SETTING: A stratified, random sample of 90 Medicaid-eligible nursing facilities in Oregon, Wisconsin, and West Virginia. PARTICIPANTS: One thousand seven hundred eleven living and deceased nursing facility residents aged 65 and older with a minimum 60-day stay. MEASUREMENTS: Life-sustaining treatment orders; pain, shortness of breath, and related treatments over a 7-day period; and use of life-sustaining treatments over a 60-day period. RESULTS: Residents with POLST forms were more likely to have orders about life-sustaining treatment preferences beyond cardiopulmonary resuscitation than residents without (98.0% vs 16.1%, P<.001). There were no differences between residents with and without POLST forms in symptom assessment or management. Residents with POLST forms indicating orders for comfort measures only were less likely to receive medical interventions (e.g., hospitalization) than residents with POLST full treatment orders (P=.004), residents with traditional do-not-resuscitate orders (P<.001), or residents with traditional full code orders (P<.001). CONCLUSION: Residents with POLST forms were more likely to have treatment preferences documented as medical orders than those who did not, but there were no differences in symptom management or assessment. POLST orders restricting medical interventions were associated with less use of life-sustaining treatments. Findings suggest that the POLST program offers significant advantages over traditional methods to communicate preferences about life-sustaining treatments.

KW - do not hospitalize

KW - do not resuscitate

KW - end-of-life

KW - ethics

KW - nursing facility

UR - http://www.scopus.com/inward/record.url?scp=77954336600&partnerID=8YFLogxK

UR - http://www.scopus.com/inward/citedby.url?scp=77954336600&partnerID=8YFLogxK

U2 - 10.1111/j.1532-5415.2010.02955.x

DO - 10.1111/j.1532-5415.2010.02955.x

M3 - Article

C2 - 20649687

AN - SCOPUS:77954336600

VL - 58

SP - 1241

EP - 1248

JO - Journal of the American Geriatrics Society

JF - Journal of the American Geriatrics Society

SN - 0002-8614

IS - 7

ER -