Factors associated with concordance between POLST orders and current treatment preferences

dc.contributor.authorHickman, Susan E.
dc.contributor.authorTorke, Alexia M.
dc.contributor.authorSachs, Greg A.
dc.contributor.authorSudore, Rebecca L.
dc.contributor.authorTang, Qing
dc.contributor.authorBakoyannis, Giorgos
dc.contributor.authorHeim Smith, Nicholette
dc.contributor.authorMyers, Anne L.
dc.contributor.authorHammes, Bernard J.
dc.contributor.departmentSchool of Nursingen_US
dc.date.accessioned2023-07-18T11:32:43Z
dc.date.available2023-07-18T11:32:43Z
dc.date.issued2021
dc.description.abstractBackground: POLST is widely used to document the treatment preferences of nursing facility residents as orders, but it is unknown how well previously completed POLST orders reflect current preferences (concordance) and what factors are associated with concordance. Objectives: To describe POLST preference concordance and identify factors associated with concordance. Design: Chart reviews to document existing POLST orders and interviews to elicit current treatment preferences. Setting: POLST-using nursing facilities (n = 29) in Indiana. Participants: Nursing facility residents (n = 123) and surrogates of residents without decisional capacity (n = 152). Measurements: Concordance was determined by comparing existing POLST orders for resuscitation, medical interventions, and artificial nutrition with current treatment preferences. Comfort-focused POLSTs contained orders for do not resuscitate, comfort measures, and no artificial nutrition. Results: Overall, 55.7% (123/221) of residents and 44.7% (152/340) of surrogates participated (total n = 275). POLST concordance was 44%, but concordance was higher for comfort-focused POLSTs (68%) than for non-comfort-focused POLSTs (27%) (p < 0.001). In the unadjusted analysis, increasing resident age (OR 1.04, 95% CI 1.01-1.07, p < 0.01), better cognitive functioning (OR 1.07, 95% CI 1.02-1.13, p < 0.01), surrogate as the decision-maker (OR 2.87, OR 1.73-4.75, p < 0.001), and comfort-focused POLSTs (OR 6.01, 95% CI 3.29-11.00, p < 0.01) were associated with concordance. In the adjusted multivariable model, only having an existing comfort-focused POLST was associated with higher odds of POLST concordance (OR 5.28, 95% CI 2.59-10.73, p < 0.01). Conclusions: Less than half of all POLST forms were concordant with current preferences, but POLST was over five times as likely to be concordant when orders reflected preferences for comfort-focused care. Findings suggest a clear need to improve the quality of POLST use in nursing facilities and focus its use among residents with stable, comfort-focused preferences.en_US
dc.eprint.versionAuthor's manuscripten_US
dc.identifier.citationHickman SE, Torke AM, Sachs GA, et al. Factors associated with concordance between POLST orders and current treatment preferences. J Am Geriatr Soc. 2021;69(7):1865-1876. doi:10.1111/jgs.17095en_US
dc.identifier.urihttps://hdl.handle.net/1805/34443
dc.language.isoen_USen_US
dc.publisherWileyen_US
dc.relation.isversionof10.1111/jgs.17095en_US
dc.relation.journalJournal of the American Geriatrics Societyen_US
dc.rightsPublisher Policyen_US
dc.sourcePMCen_US
dc.subjectAdvance care planningen_US
dc.subjectNursing homeen_US
dc.subjectPalliative careen_US
dc.titleFactors associated with concordance between POLST orders and current treatment preferencesen_US
dc.typeArticleen_US
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