Factors associated with concordance between POLST orders and current treatment preferences.
Factors associated with concordance between POLST orders and current treatment preferences.
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DOI：
10.1111/jgs.17095
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发表时间：
2021-07
影响因子：
6.3
通讯作者：
Hammes BJ
中科院分区：
文献类型：
--
作者：
Hickman SE;Torke AM;Sachs GA;Sudore RL;Tang Q;Bakoyannis G;Heim Smith N;Myers AL;Hammes BJ
POLST被广泛用于记录护理机构居民的治疗偏好，但目前尚不清楚先前完成的POLST订单在多大程度上反映了当前的偏好（一致性），以及哪些因素与一致性相关。描述POLST偏好一致性并确定与一致性相关的因素。图表回顾，记录当前POLST订单和访谈，以引出当前的治疗偏好。印第安纳州使用polst的护理设施（n = 29）。护理机构居民（n = 123）和没有决策能力的居民的代理人（n = 152）。通过比较现有的POLST复苏、医疗干预和人工营养订单与当前的治疗偏好来确定一致性。以舒适为重点的POLSTs包含不复苏、舒适措施和不人工营养的命令。总体而言，55.7%（123/221）的居民和44.7%（152/340）的代理人参与了调查（总n = 275）。POLST的一致性为44%，但舒适关注的POLST的一致性（68%）高于非舒适关注的POLST (27%) （p < 0.001）。在未经调整的分析中，居民年龄的增加（OR 1.04, 95% CI 1.01 - 1.07, p < 0.01）、更好的认知功能（OR 1.07, 95% CI 1.02 - 1.13, p < 0.01）、作为决策者的代理人（OR 2.87, OR 1.73 - 4.75, p < 0.001）和以舒适为中心的POLSTs （OR 6.01, 95% CI 3.29 - 11.00, p < 0.01）与一致性相关。在调整后的多变量模型中，仅存在以舒适为重点的POLST与POLST一致性的较高几率相关（OR 5.28, 95% CI 2.59 - 10.73, p < 0.01）。不到一半的POLST表格与当前的偏好一致，但当订单反映了以舒适为重点的护理偏好时，POLST的一致性超过5倍。研究结果表明，明显需要提高POLST在护理机构中的使用质量，并将其使用重点放在具有稳定、舒适偏好的居民中。
POLST is widely used to document the treatment preferences of nursing facility residents as orders, but it is unknown how well previously completed POLST orders reflect current preferences (concordance) and what factors are associated with concordance. To describe POLST preference concordance and identify factors associated with concordance. Chart reviews to document current POLST orders and interviews to elicit current treatment preferences. POLST-using nursing facilities (n = 29) in Indiana. Nursing facility residents (n = 123) and surrogates of residents without decisional capacity (n = 152). Concordance was determined by comparing existing POLST orders for resuscitation, medical interventions, and artificial nutrition with current treatment preferences. Comfort-focused POLSTs contained orders for do not resuscitate, comfort measures, and no artificial nutrition. Overall, 55.7% (123/221) of residents and 44.7% (152/340) of surrogates participated (total n = 275). POLST concordance was 44%, but concordance was higher for comfort-focused POLSTs (68%) than for non-comfort-focused POLSTs (27%) (p < .001). In the unadjusted analysis, increasing resident age (OR 1.04, 95% CI 1.01 – 1.07, p < .01), better cognitive functioning (OR 1.07, 95% CI 1.02 – 1.13, p < .01), surrogate as the decision-maker (OR 2.87, OR 1.73 – 4.75, p < .001), and comfort-focused POLSTs (OR 6.01, 95% CI 3.29 – 11.00, p < .01) were associated with concordance. In the adjusted multivariable model, only having an existing comfort-focused POLST was associated with higher odds of POLST concordance (OR 5.28, 95% CI 2.59 – 10.73, p < .01). Less than half of all POLST forms were concordant with current preferences, but POLST was over 5 times as likely to be concordant when orders reflected preferences for comfort-focused care. Findings suggest a clear need to improve the quality of POLST use in nursing facilities and focus its use among residents with stable, comfort-focused preferences.
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