POLST Facilitation in Complex Care Management: A Feasibility Study

Alexia Torke, Susan Hickman, Bernard Hammes, Steven Counsell, Lev Inger, James E. Slaven, Dawn Butler

Research output: Contribution to journalArticle

Abstract

Background: The Physician Orders for Life-Sustaining Treatment (POLST) form is an advance care planning tool designed for seriously ill patients. The discussions needed for high-quality POLST decision-making are time intensive and often do not occur in the outpatient setting. Objective: We conducted a single-arm feasibility study of POLST facilitation by nonphysicians using Respecting Choices Last Steps, a standardized, structured approach to facilitation of POLST conversations. Setting/Participants: Community-dwelling adults aged 65 and older enrolled in a complex care management program in a Midwestern urban hospital. Measurements: We assessed the feasibility and acceptability by determining the proportion of eligible patients who enrolled and completed the study, by adherence to the Respecting Choices protocol, and by responses to qualitative and quantitative survey items about the intervention. Results: We enrolled 18 (58.1%) of 31 eligible patients, with a mean age of 77.8 years (standard deviation: 6.95); 12 were African American. The POLST facilitation was delivered to all 18; 10 (55.6%) completed POLST forms. Direct observation of intervention delivery using a checklist found 85% of the required elements were performed by facilitators. We completed 6- to 8-week follow-up interviews in 16 of 18 patients (88.9%). We found 87.5% of decision makers agreed or strongly agreed that “Talking about the (POLST) form helped me think about what I really want.” Conclusions: The POLST facilitation can be successfully delivered to frail older adults in a complex care management setting, with high fidelity to protocol. Further research is needed to demonstrate the effects of this approach on decision quality and other patient-reported outcomes.

Original languageEnglish (US)
JournalAmerican Journal of Hospice and Palliative Medicine
DOIs
StateAccepted/In press - Jan 1 2018

Fingerprint

Feasibility Studies
Physicians
Therapeutics
Advance Care Planning
Independent Living
Frail Elderly
Urban Hospitals
Checklist
African Americans
Decision Making
Outpatients
Observation
Interviews
Research

Keywords

  • advance directives
  • bioethics
  • end-of-life care
  • ethics
  • palliative care
  • physician–patient communication

ASJC Scopus subject areas

  • Medicine(all)

Cite this

POLST Facilitation in Complex Care Management : A Feasibility Study. / Torke, Alexia; Hickman, Susan; Hammes, Bernard; Counsell, Steven; Inger, Lev; Slaven, James E.; Butler, Dawn.

In: American Journal of Hospice and Palliative Medicine, 01.01.2018.

Research output: Contribution to journalArticle

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