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Cited by 203Palliative Care and End-of-Life IssuesGeriatric Care and Nursing HomesPalliative and Oncologic Care

A comparison of methods to communicate treatment preferences in nursing facilities: traditional practices versus the physician orders for life-sustaining treatment program

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Hickman, Susan E., Nelson, Christine A., Perrin, Nancy A., Moss, Alvin H., Hammes, Bernard J., Tolle, Susan W.·2010·Journal of the American Geriatrics Society
DOI 10.1111/j.1532-5415.2010.02955.xPMC PMC2963454
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Abstract

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.

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  • Evaluations of the POLST have shown that the system improved communication, implementation of end-of-life preferences and patient satisfaction.

    “Evaluations of the POLST have shown that the system improved communication, 25,26 implementation of end-of-life preferences and patient satisfaction.[27][28][29][30][31]”

    From Recommended summary plan for emergency care and treatment: ReSPECT a mixed-methods study (2022) · cites this paper as [25]

    The Results and Discussion (page not available in our copy) report that POLST users more often had treatment preferences documented as actionable orders and that Comfort Measures Only orders were associated with fewer life-sustaining interventions. This supports improved implementation of preferences in nursing facilities, though the study is observational. It does not report patient satisfaction, so that part of the attributed claim is unsupported. (LLM, conf=0.86)

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Authors
Hickman, S. E., Nelson, C. A., Perrin, N. A., Moss, A. H., Hammes, B. J., & Tolle, S. W.
Affiliations
  • Indiana University Indianapolis (US)
  • Kaiser Permanente (US)
  • West Virginia University (US)
  • Gundersen Lutheran Hospital (US)
  • Oregon Health & Science University (US)
ORCID
Venue
Journal of the American Geriatrics Society
Publisher
Wiley
Published
2010-07
Volume
58
Issue
7
Pages
1241-1248
ISSN
  • 0002-8614 (ISSN-L)
  • 1532-5415
DOI
10.1111/j.1532-5415.2010.02955.x
PMC
PMC2963454
OpenAlex
W2134842875
Cited by
203
References
32
Citations by year
2026: 1 · 2025: 3 · 2024: 5 · 2023: 2 · 2022: 16 · 2021: 10 · 2020: 15 · 2019: 14 · 2018: 10 · 2017: 11 · 2016: 17 · 2015: 20 · 2014: 20 · 2013: 18 · 2012: 14
FWCI
18.06
Type
journal article
Language
en
Open access
Licence
onlinelibrary.wiley.com/termsAndConditions#vor (vor, 1 d)
Locations
  • Journal of the American Geriatrics Society (publishedVersion)
  • PubMed (publishedVersion)
  • Europe PMC (PubMed Central) (acceptedVersion)
  • PubMed Central (acceptedVersion)
  • DigitalGeorgetown (Georgetown University Library) (submittedVersion)
  • IUScholarWorks (Indiana University) (submittedVersion)
  • Purdue University Indianapolis (Indiana University) (submittedVersion)
Funders
National Institute of Nursing Research (R01NR009784, NR009784)
Topics
  • Health Sciences › Medicine › Public Health, Environmental and Occupational Health › Palliative Care and End-of-Life Issues
  • Health Sciences › Health Professions › General Health Professions › Geriatric Care and Nursing Homes
  • Health Sciences › Medicine › Public Health, Environmental and Occupational Health › Palliative and Oncologic Care
Keywords
POLST, life-sustaining treatment preferences, nursing home residents, do-not-resuscitate orders, comfort measures only, end-of-life care, advance care planning, older adults
MeSH terms
Aged, Aged, 80 and over, Communication, Female, Forms and Records Control, Humans, Male, Medical Records, Retrospective Studies, Skilled Nursing Facilities, Cohort Studies, Advance Directives, Resuscitation Orders, Patient Preference

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