A comparison of methods to communicate treatment preferences in nursing facilities: traditional practices versus the physician orders for life-sustaining treatment program.
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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DOI：
10.1111/j.1532-5415.2010.02955.x
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发表时间：
2010-07
影响因子：
6.3
通讯作者：
Tolle SW
中科院分区：
文献类型：
--
作者：
Hickman SE;Nelson CA;Perrin NA;Moss AH;Hammes BJ;Tolle SW
传达维持生命的治疗偏好的传统方法在很大程度上是无效的。生命维持治疗医生订单(POLST)计划提供了另一种方法，但缺乏比较数据。评估沟通方法(POLST与传统做法)与维持生命治疗指令的记录、症状评估和管理以及维持生命治疗的使用之间的关系。2006年6月至2007年4月间进行的回溯性观察队列研究。对俄勒冈州、威斯康星州和西弗吉尼亚州的90家符合医疗补助条件的护理机构进行分层随机抽样。1711名65岁及以上的在世和已故护理机构居民，至少居住60天。维持生命的治疗顺序；7天期间的疼痛、呼吸急促和相关治疗；以及60天期间的生命维持治疗的使用。与非POLST使用者相比，POLST使用者比非POLST使用者更有可能接受CPR以外的维持生命治疗偏好(98.0%比16.1%，P<；.001)。POLST使用者与非POLST使用者在症状评估或管理上无差异。仅订购舒适措施的POLST用户接受医疗干预(例如住院)的可能性低于持有POLST全治疗订单的居民(P=.004)、具有传统DNR订单的居民(P<；.001)或具有传统全代码订单的居民(P<；.001)。POLST使用者比非POLST使用者更有可能将治疗偏好记录为医嘱，但在症状管理或评估方面没有差异。POLST限制医疗干预的命令与较少使用维持生命的治疗有关。研究结果表明，与传统方法相比，POLST计划在传达对维持生命治疗的偏好方面具有显著优势。
Traditional methods to communicate life-sustaining treatment preferences are largely ineffective. The Physician Orders for Life-Sustaining Treatment (POLST) Program offers an alternative approach, but comparative data are lacking. To evaluate the relationship between communication methods (POLST versus traditional practices) and documentation of life-sustaining treatment orders, symptom assessment and management, and use of life-sustaining treatments. Retrospective observational cohort study conducted between June 2006 and April 2007. A stratified, random sample of 90 Medicaid-eligible nursing facilities in Oregon, Wisconsin, and West Virginia. 1711 living and deceased nursing facility residents aged 65 and older with a minimum 60-day stay. 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. POLST users were more likely to have orders about life-sustaining treatment preferences beyond CPR than non-POLST users (98.0% vs. 16.1%, P<.001). There were no differences between POLST users and non-users in symptom assessment or management. POLST users with 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 DNR orders (P<.001), or residents with Traditional Full Code orders (P<.001). POLST users were more likely to have treatment preferences documented as medical orders than non-POLST users but there were no differences in symptom management or assessment. POLST orders restricting medical interventions were associated with the lower use of life-sustaining treatments. Findings suggest the POLST program offers significant advantages over traditional methods to communicate preferences about life-sustaining treatments.
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DOI：
10.1111/j.1532-5415.1997.tb05178.x
发表时间：
1997-04-01
影响因子：
6.3
作者：
Teno, J;Lynn, J;Knaus, WA
通讯作者：
Knaus, WA
影响因子：
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作者：
Hammes, BJ;Rooney, BL
通讯作者：
Rooney, BL
DOI：
10.1111/j.1532-5415.2000.tb02594.x
发表时间：
2000-10-01
影响因子：
6.3
作者：
Lee, MA;Brummel-Smith, K;London, MR
通讯作者：
London, MR
影响因子：
2.8
作者：
Hickman, Susan E.;Nelson, Christine A.;Tolle, Susan W.
通讯作者：
Tolle, Susan W.
DOI：
10.1046/j.1532-5415.2002.50117.x
发表时间：
2002-03-01
影响因子：
6.3
作者：
Hall, P;Schroder, C;Weaver, L
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