Converting Treatment Wishes into Orders at End of Life

说明(由申请人提供)：传统的预先指示一直被认为是改善护理机构居民临终关怀的一种手段，方法是提供治疗偏好的文件，以便于决策。然而，传统的指令是有问题的，因为它们不能转化为立即的医疗命令，以指导基于居民当前健康状况的具体治疗决定。POLSY(维持生命治疗医生订单)计划的核心是一份进步的指令文件，它引起了全国各地寻求改善临终关怀的社区的注意。POLST表格已经在整个美国被纳入实践，尽管关于这一计划的有效性的数据很少。将对POLST计划进行一项多地点研究，以：1)比较POLST计划和传统预先护理计划在将治疗偏好转换为订单方面的有效性；2)确定预先护理计划实践对症状管理的影响；3)比较POLST表格和传统预先护理计划的护理机构居民使用特定维持生命治疗的情况；以及4)评估POLST计划的设施使用是否与差异有关，以及是否与来自国家数据集的临终指标的差异相关。俄勒冈州、威斯康星州和西弗吉尼亚州的护理设施将通过电话进行调查，以评估POLST计划的高级规划实践和使用情况。接下来，将在每个州的大约30个护理机构进行图表审查，以获得带有和不带有POLST表格的1800张图表样本。还将获得联邦数据，以评估POLST计划使用、联邦医疗保险和最低数据集寿命终结变量之间的关系。在本申请中提出的研究具有重要意义，因为它将提供与传统预先护理计划相比的渐进式指导计划的有效性的关键数据。研究结果将为POLST形式的进一步变化提供信息，指导教育规划的发展，提供有关护理机构临终关怀的详细信息，并建议政策变化以改善临终关怀。

DESCRIPTION (provided by applicant): Traditional advance directives have been advocated as 1 means to improve end-of-life care for nursing facility residents by providing documentation of treatment preferences to facilitate decision-making. However, traditional directives are problematic because they do not translate into immediate medical orders to guide specific treatment decisions based on a resident's current health status. The centerpiece of the POLSY (Physician Orders for Life-Sustaining Treatment) Program is a progressive directive document that has caught the attention of communities around the country seeking to improve end-of-life care. The POLST form has been incorporated into practice throughout the United States despite minimal data regarding the efficacy of this program. A multi-site study of the POLST Program will be conducted in order to: 1) compare the effectiveness of the POLST Program with traditional advance care planning in converting treatment preferences into orders; 2) determine the effect of advance care planning practices on symptom management; 3) compare the use of specific life-sustaining treatments for nursing facility residents with POLST forms to those with traditional advance care planning; and 4) assess whether facility use of the POLST program is associated with differences is associated with differences in end-of-life indicators from national data sets. Nursing facilities in Oregon, Wisconsin, and West Virginia will be surveyed by telephone to assess advance planning practices and use of the POLST program. Next, chart reviews will be conducted at approximately 30 nursing facilities in each state to obtain a sample of 1800 charts with and without POLST forms. Federal data will also be obtained to assess the relationship between POLST program use, Medicare, and Minimum Data Set end-of-life variables. The research proposed in this application is significant because it will provide critical data about the effectiveness of a progressive directive program in comparison to traditional advance care planning. Study findings will inform further changes to the POLST form, guide the development of educational programming, provide detailed information about end-of-life care in nursing facilities, and suggest policy change to improve care at the end of life.