Exploring provider-surrogate communication during POLST discussions for individuals with advanced dementia

Hyejin Kim, Christine Bradway, Susan E. Hickman, Mary Ersek

Research output: Contribution to journalArticle

Abstract

Objectives: This qualitative descriptive study explored provider-surrogate communication during Physician Orders for Life-Sustaining Treatment (POLST) discussions for patients with advanced dementia. Methods: Data from participant observations and audio-recordings of ten POLST discussions were analyzed using directed content analysis within the context of an existing conceptual model of Communication and Surrogate Decision Making. Results: Surrogates primarily focused on making sense of the clinical information about life-sustaining treatments during POLST conversations. Providers delivered clinical information about the trajectory of dementia, life-sustaining treatments, and/or features of POLST. They also demonstrated emotional support, by valuing what the surrogate said, acknowledging the surrogate's emotions, listening carefully, understanding the patient as a person, and eliciting questions. However, providers rarely conveyed comprehensive information about the patient's current condition and end-of-life treatment options. Also, open communication of expectations and preferred decision-making roles was rarely observed during the discussions. Conclusion: Findings highlight areas that require providers’ attention to conduct effective communication, such as delivering comprehensive information about life-sustaining treatments including discussion of risks and benefits in the context of dementia. Findings also support the use of the conceptual model as a framework to examine provider-surrogate communication in the context of POLST discussions, advanced dementia, and non-hospital settings. Additional research is necessary to confirm these findings in larger, more diverse groups of patients, surrogates, and providers.

Original languageEnglish (US)
Pages (from-to)781-791
Number of pages11
JournalAging and Mental Health
Volume23
Issue number6
DOIs
StatePublished - Jun 3 2019

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Keywords

  • Surrogate decision making
  • dementia
  • end-of-life care planning
  • palliative care
  • physician orders for life-sustaining treatment

ASJC Scopus subject areas

  • Phychiatric Mental Health
  • Gerontology
  • Geriatrics and Gerontology
  • Psychiatry and Mental health

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