Use of the Physician Orders for Life-Sustaining Treatment (POLST) Paradigm Program in the Hospice Setting
Use of the Physician Orders for Life-Sustaining Treatment (POLST) Paradigm Program in the Hospice Setting
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DOI：
10.1089/jpm.2008.0196
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发表时间：
2009-02-01
影响因子：
2.8
通讯作者：
Tolle, Susan W.
中科院分区：
文献类型：
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作者：
Hickman, Susan E.;Nelson, Christine A.;Tolle, Susan W.
背景：医师维持生命治疗指令（POLST）范例项目旨在确保在整个医疗保健系统中尊重患者的全部治疗偏好。关于在安宁疗护环境中使用POLST的资料缺乏。目的：评估安宁疗护计划对POLST的使用、安宁疗护人员对POLST的态度、POLST对维持生命治疗使用的影响，以及安宁疗护病人选择的治疗方案类型。设计：对三个州（俄勒冈州、威斯康星州和西弗吉尼亚州）的所有临终关怀项目进行电话调查，以评估POLST的使用情况。报告使用POLST的临终关怀医院工作人员（n = 71）被问及关于他们对POLST态度的附加问题。在俄勒冈州（n = 8）、西弗吉尼亚州（n = 5）和威斯康星州（n = 2）使用polst的项目的子样本中进行了图表回顾。结果：POLST在俄勒冈州（100%）和西弗吉尼亚州（85%）的临终关怀医院广泛使用，但在威斯康星州（6%）仅在局部地区使用。大多数接受采访的临终关怀工作人员认为POLST在防止不必要的复苏（97%）和发起关于治疗偏好的对话（96%）方面是有用的。在98%的病例中，对治疗限制的偏好得到了尊重，没有人接受了不必要的心肺复苏（CPR）、插管、重症监护或喂食管。大多数接受“不复苏”（DNR）指令的临终关怀病人（78%）希望在至少一种其他类别（如抗生素或住院治疗）中获得最低水平以上的治疗。结论：安宁疗护人员认为POLST是有用、有帮助且可靠的。它能有效地确保对限制的偏好得到尊重。当给予选择时，大多数安宁疗护病人希望在特定情况下选择更积极的治疗。
Background: The Physician Orders for Life-Sustaining Treatment (POLST) Paradigm Program was designed to ensure the full range of patient treatment preferences are honored throughout the health care system. Data are lacking about the use of POLST in the hospice setting.Objective: To assess use of the POLST by hospice programs, attitudes of hospice personnel toward POLST, the effect of POLST on the use of life-sustaining treatments, and the types of treatments options selected by hospice patients.Design: A telephone survey was conducted of all hospice programs in three states (Oregon, Wisconsin, and West Virginia) to assess POLST use. Staff at hospices reporting POLST use (n = 71) were asked additional questions about their attitudes toward the POLST. Chart reviews were conducted at a subsample of POLST-using programs in Oregon (n = 8), West Virginia (n = 5), and Wisconsin (n = 2).Results: The POLST is used widely in hospices in Oregon (100%) and West Virginia (85%) but only regionally in Wisconsin (6%). A majority of hospice staff interviewed believe the POLST is useful at preventing unwanted resuscitation (97%) and at initiating conversations about treatment preferences (96%). Preferences for treatment limitations were respected in 98% of cases and no one received unwanted cardiopulmonary resuscitation (CPR), intubation, intensive care, or feeding tubes. A majority of hospice patients (78%) with do-not-resuscitate (DNR) orders wanted more than the lowest level of treatment in at least one other category such as antibiotics or hospitalization.Conclusions: The POLST is viewed by hospice personnel as useful, helpful, and reliable. It is effective at ensuring preferences for limitations are honored. When given a choice, most hospice patients want the option for more aggressive treatments in selected situations.