Reasons for discordance and concordance between POLST orders and current treatment preferences.
Reasons for discordance and concordance between POLST orders and current treatment preferences.
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DOI：
10.1111/jgs.17097
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发表时间：
2021-07
影响因子：
6.3
通讯作者：
Sachs GA
中科院分区：
文献类型：
--
作者：
Hickman SE;Torke AM;Heim Smith N;Myers AL;Sudore RL;Hammes BJ;Sachs GA
先期护理计划文件与当前偏好之间不一致的原因尚不清楚。POLST表格提供了一个独特的机会，可以了解与POLST相关的不一致和不一致的原因，以及一般的高级护理规划。定性描述，包括案例内部和跨案例的持续比较分析。印第安纳州的26家护理机构。居民(n=36)和无决策能力居民的代理决策者(n=37)。使用半结构化访谈指南来探讨当前偏好与现有POLST表格之间不一致或不一致的原因。不一致的原因包括：1)与POLST完成相关的护理设施实践问题；2)遗漏关于POLST治疗决定的关键信息；3)推迟到其他人；以及4)随着时间的推移而改变。由于缺乏洞察力或无法记住最初POLST对话的细节，一些参与者无法解释这种不一致。对一致性的解释包括：1)居民的健康状况没有变化和/或居民的病情不太可能改善；2)使用替代判断标准进行代孕决策；以及3)对什么是“正确”的固定看法，几乎没有洞察力。参与者解释了现有POLST订单和当前偏好之间的不一致性，强调了适当的结构和流程的重要性，以支持护理机构的高质量提前护理规划。与预后不太明确的居民相比，健康状况稳定或较差的居民可能更适合进行提前护理计划对话，尽管应定期重新评估偏好，以及当病情发生变化时，以帮助确保现有文件与当前的治疗偏好一致。
The reasons for discordance between advance care planning documentation and current preferences are not well understood. The POLST form offers a unique opportunity to learn about the reasons for discordance and concordance that has relevance for POLST as well as advance care planning generally. Qualitative descriptive including constant comparative analysis within and across cases. 26 nursing facilities in Indiana. Residents (n=36) and surrogate decision-makers of residents without decisional capacity (n=37). A semi-structured interview guide was used to explore the reasons for discordance or concordance between current preferences and existing POLST forms. Reasons for discordance include: 1) problematic nursing facility practices related to POLST completion; 2) missing key information about POLST treatment decisions; 3) deferring to others; and 4) changes over time. Some participants were unable to explain the discordance due to a lack of insight or inability to remember details of the original POLST conversation. Explanations for concordance include: 1) no change in the resident’s medical condition and/or the resident is unlikely to improve; 2) use of the substituted judgment standard for surrogate decision-making; and 3) fixed opinion about what is “right” with little to no insight. Participant explanations for discordance between existing POLST orders and current preferences highlight the importance of adequate structures and processes to support high quality advance care planning in nursing facilities. Residents with stable or poor health may be more appropriate candidates for engaging in advance care planning conversations than residents with a less clear prognosis, though preferences should be revisited periodically as well as when there is a change in condition to help ensure existing documentation is concordant with current treatment preferences.
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影响因子：
--
作者：
LAVELLEJONES, C;BYRNE, DJ;CUSCHIERI, A
通讯作者：
CUSCHIERI, A
影响因子：
6.3
作者：
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通讯作者：
Bennett DA
影响因子：
4.7
作者：
Cohen, Simon M.;Volandes, Angelo E.;Mitchell, Susan L.
通讯作者：
Mitchell, Susan L.
影响因子：
5.7
作者：
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通讯作者：
VanRyn, Michelle
影响因子：
5.7
作者：
Bosslet, Gabriel T.;Torke, Alexia M.;Helft, Paul R.
通讯作者：
Helft, Paul R.