A Comparison of Methods to Communicate Treatment Preferences in Nursing Facilities: Traditional Practices Versus the Physician Orders for Life-Sustaining Treatment Program

• Published in: Journal of the American Geriatrics Society (JAGS) Vol. 58; no. 7; pp. 1241 - 1248
• Main Authors: Hickman, Susan E., Nelson, Christine A., Perrin, Nancy A., Moss, Alvin H., Hammes, Bernard J., Tolle, Susan W.
• Format: Journal Article
• Language: English
• Published: Malden, USA Blackwell Publishing Inc 01-07-2010; Wiley-Blackwell; Wiley Subscription Services, Inc
• Subjects: Advance Directives; Aged; Aged, 80 and over; Biological and medical sciences; Cohort Studies; Communication; Comparative studies; do not hospitalize; do not resuscitate; end-of-life; Ethics; Female; Forms and Records Control; General aspects; Health participants; Humans; Life support systems; Male; Medical Records; Medical sciences; Methods; nursing facility; Nursing homes; Older people; Patient Preference; Preferences; Public health. Hygiene; Public health. Hygiene-occupational medicine; Resuscitation Orders; Retrospective Studies; Skilled Nursing Facilities; Methodology; Health staff; nursing facility; Specialized institution; Physician; end-of-life; do not hospitalize; End of life; Method; Ethics; Treatment; Preference; Professional practice; do not resuscitate; Therapeutic schedule; Homes for the aged; Nursing home; Comparative study; Public health; Geriatrics
• ISSN: 0002-8614; 1532-5415
• DOI: 10.1111/j.1532-5415.2010.02955.x

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.