Physician orders for life-sustaining treatment (POLST): Outcomes in a PACE program
Physician orders for life-sustaining treatment (POLST): Outcomes in a PACE program
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DOI：
10.1111/j.1532-5415.2000.tb02594.x
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发表时间：
2000-10-01
影响因子：
6.3
通讯作者：
London, MR
中科院分区：
文献类型：
--
作者：
Lee, MA;Brummel-Smith, K;London, MR
目标：评价临终关怀是否与生命维持治疗医嘱（POLST）一致，POLST是一种预先打印并签署的医嘱，规定了在发生严重疾病时的心肺复苏术、医疗干预、抗生素、IV液体和饲管的水平的治疗说明。设计：回顾性病历回顾。所有在1997年去世的老年人参与者都有资格（n =58）。排除的原因是没有POLST（1），失踪POLST（1），和护理文件不足（2）。测量：POLST的指示，为每个参与者，无论是每一个处理的POLST是管理在最后2周的生命。结果：POLST规定“不复苏”的50名参与者（93%）; 49名参与者（91%）的CPR使用与这些说明一致。“舒适护理”是13例病例的指定医疗干预水平，“有限干预”是18例，“高级干预”是18例，“全面干预”是5例。在25例（46%）中，给予的干预措施处于指定水平;在18例（33%）中，干预措施处于侵入性较低的水平，在11例（20%）中，干预措施处于侵入性较高的水平。在生命的最后2周内发生感染的28例受试者中，86%的受试者的抗生素给药与POLST说明一致，14%的受试者的侵入性较低。护理相匹配的POLST指令在84%的情况下，电视液和94%的feedingtubes.Conclusions：POLST完成在ElderPlace超过报告的提前指示率。护理匹配POLST的心肺复苏术，抗生素，电视液，和饲管的指示比以前报告的提前指示更一致。然而，不到一半的参与者的医疗干预水平与POLST指示一致。我们的结论是，POLST是有效的限制使用一些维持生命的干预措施，但导致医生偏离患者的陈述偏好的因素值得进一步调查。
OBJECTIVES: To evaluate whether terminal care was consistent with Physician Orders for Life-Sustaining Treatment (POLST), a preprinted and signed doctor's order specifying treatment instructions in the event of serious illness for CPR, levels of medical intervention, antibiotics, IV fluids, and feeding tubes.DESIGN: Retrospective chart review.SETTING: ElderPlace, a Program of All-Inclusive Care for the Elderly (PACE) site in Portland, Oregon.PARTICIPANTS: All ElderPlace participants who died in 1997 were eligible (n =58). Reasons for exclusion were no POLST (1), missing POLST (1), and insufficient documentation of care (2).MEASUREMENTS: POLST instructions for each participant and whether or not each of the treatments addressed by the POLST was administered in the final 2 weeks of life.RESULTS: The POLST specified "do not resuscitate" for 50 participants (93%); CPR use was consistent with these instructions for 49 participants (91%). "Comfort care" was the designated level of medical intervention in 13 cases, "limited interventions" in 18, "advanced interventions;" in 18, and "full interventions" in 5. Interventions administered were at the level specified in 25 cases (46%); at a less invasive level in 18 (33%), and at a more invasive level in 11 (20%). Antibiotic administration was consistent with POLST instructions for 86% of 28 subjects who had infections in the last 2 weeks of life, and less invasive for 14%. Care matched POLST instructions in 84% of cases for TV fluids and 94% for feeding tubes.CONCLUSIONS: POLST completion in ElderPlace exceeds reported advance directive rates. Care matched POLST instructions for CPR, antibiotics, TV fluids, and feeding tubes more consistently than previously reported for advance directive instructions. Medical intervention level was consistent with POLST instructions for less than half the participants, however. We conclude that the POLST is effective for limiting the use of some life-sustaining interventions, but that the factors that lead physicians to deviate from patients' stated preferences merit further investigation.