Reasons for Discordance Between Life-Sustaining Treatment Preferences and Medical Orders in Nursing Facilities Without POLST

dc.contributor.authorHeim Smith, Nicholette L.
dc.contributor.authorSudore, Rebecca L.
dc.contributor.authorMyers, Anne L.
dc.contributor.authorHammes, Bernard J.
dc.contributor.authorHickman, Susan E.
dc.contributor.departmentSchool of Nursing
dc.date.accessioned2024-03-08T16:32:49Z
dc.date.available2024-03-08T16:32:49Z
dc.date.issued2023
dc.description.abstractBackground: Life-sustaining treatment (LST) orders are important communication tools used to ensure preference-concordant care at the end of life. Recent studies reveal concerning rates of discordance between current preferences and documented LST orders, especially in nursing facilities without POLST. Reasons for discordance in facilities using POLST have been explored, however the majority of nursing facilities in the United States do not yet use the POLST form. Design: Qualitative descriptive study using constant comparative analysis. Setting: Nursing facilities in Indiana (n = 6) not using POLST. Participants: Residents (n = 15) and surrogate decision-makers of residents without decisional capacity (n = 15) with discordance between current preferences and documented LST orders. Measurements: Do not resuscitate, do not hospitalize (DNH), and do not intubate (DNI) orders were extracted from medical charts. Current preferences were elicited using the Respecting Choices Advanced Steps model. A semi-structured interview guide was used to explore reasons for discordance between current preferences and LST orders. Results: Reasons for discordance included: (1) inadequate information about the range of available LST options, what each involves, and how to formally communicate preferences; (2) no previous discussion with facility staff; (3) no documentation of previously expressed preferences; and (4) family involvement. Conclusion: Reasons for discordance between expressed preferences and LST orders suggest that in facilities without a uniform and systematic LST order documentation strategy like POLST, these conversations may not occur and/or be documented. Staff should be aware that residents and surrogates may have preferences about LSTs that require strategic solicitation and documentation.
dc.eprint.versionAuthor's manuscript
dc.identifier.citationHeim Smith NL, Sudore RL, Myers AL, Hammes BJ, Hickman SE. Reasons for Discordance Between Life-Sustaining Treatment Preferences and Medical Orders in Nursing Facilities Without POLST. Am J Hosp Palliat Care. 2023;40(8):837-843. doi:10.1177/10499091221127996
dc.identifier.urihttps://hdl.handle.net/1805/39129
dc.language.isoen_US
dc.publisherSage
dc.relation.isversionof10.1177/10499091221127996
dc.relation.journalAmerican Journal of Hospice and Palliative Medicine
dc.rightsPublisher Policy
dc.sourcePMC
dc.subjectLife-sustaining treatments
dc.subjectPreference discordance
dc.subjectNursing home
dc.subjectAdvance care planning
dc.subjectEnd-of-life care
dc.subjectPOLST
dc.titleReasons for Discordance Between Life-Sustaining Treatment Preferences and Medical Orders in Nursing Facilities Without POLST
dc.typeArticle
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