Use of the Physician Orders for Life-Sustaining Treatment Program in the Clinical Setting: A Systematic Review of the Literature
Use of the Physician Orders for Life-Sustaining Treatment Program in the Clinical Setting: A Systematic Review of the Literature
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DOI：
10.1111/jgs.13248
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发表时间：
2015-02-01
影响因子：
6.3
通讯作者：
Hammes, Bernard J.
中科院分区：
文献类型：
--
作者：
Hickman, Susan E.;Keevern, Elisabeth;Hammes, Bernard J.
医师维持生命治疗医嘱（POLST）表格是一种姑息治疗工具，包含标准化的、可操作的医嘱。它旨在确保在整个医疗保健系统中引起、沟通和尊重患者的治疗偏好。对文献进行了系统的回顾，以评估目前对POLST计划的了解并确定未来研究的方向。我们确定了23项关于POLST在临床应用的研究。大多数研究全部或部分在俄勒冈州进行，图表审查是最常用的方法。研究表明，POLST最常用于接近生命终点的老年白人患者。非医师调解员通常准备POLST表格供医师审阅和签字。POLST上记录的医嘱反映了广泛的个性化程度，只有大约三分之一的患者的医嘱反映了所有POLST表格中最低水平的治疗。临床医生普遍对使用POLST持积极态度，但报告了广泛的挑战。POLST以与订单一致的方式改变治疗。然而，POLST反映患者或替代治疗偏好的证据缺乏。研究需要评估POLST决策的质量，探索患者及其代理人的经验，开发决策支持工具，改善临床医生教育，并通过干预和基于人群的研究评估POLST对护理结果的影响。
The Physician Orders for Life-Sustaining Treatment (POLST) form is a palliative care tool that contains standardized, actionable medical orders. It is designed to ensure that patient treatment preferences are elicited, communicated, and honored throughout the healthcare system. A systematic review of the literature was conducted to evaluate what is currently known about the POLST program and identify directions for future research. Twenty-three research studies focused on POLST use in the clinical setting were identified. A majority of studies have been conducted all or in part in Oregon, with chart review the most frequently used methodology. Research suggests that POLST is most commonly used in older, white patients who are near the end of life. A nonphysician facilitator usually prepares the POLST form for the physician to review and sign. The orders documented on POLST reflect a wide degree of individualization, with only approximately one-third of patients having orders reflecting the lowest level of treatment in all POLST form sections. Clinicians have generally positive attitudes regarding use of POLST yet report a wide range of challenges. POLST alters treatment in a way that is consistent with orders. However, evidence that POLST reflects patient or surrogate treatment preferences is lacking. Research is needed to evaluate the quality of POLST decisions, explore the experiences of patients and their surrogates, develop decision-support tools, improve clinician education, and assess the effect of POLST on care outcomes through intervention and population-based studies.