Converting Treatment Wishes into Orders at End of Life

描述（由申请人提供）：传统的预先指示被提倡作为改善护理机构居民临终关怀的一种手段，通过提供治疗偏好的文件来促进决策。然而，传统的指令是有问题的，因为它们不能立即转化为医疗命令，以指导基于居民当前健康状况的具体治疗决定。POLSY（生命维持治疗医师指令）项目的核心是一份进步的指导性文件，它引起了全国各地寻求改善临终关怀的社区的注意。尽管关于该项目的有效性的数据很少，但POLST表格已在美国各地被纳入实践。POLST项目将进行一项多地点研究，目的是：1)比较POLST项目与传统的提前护理计划在将治疗偏好转化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)比较使用POLST表格的护理机构居民与使用传统预先护理计划的护理机构居民对特定生命维持治疗的使用情况；4)评估POLST项目的设施使用是否与国家数据集的寿命终止指标差异相关。俄勒冈州、威斯康星州和西弗吉尼亚州的护理机构将接受电话调查，以评估POLST项目的提前规划实践和使用情况。接下来，将在每个州的大约30家护理机构进行图表审查，以获得1800张带有或不带有POLST表格的图表样本。还将获得联邦数据，以评估POLST项目使用、医疗保险和最小数据集寿命结束变量之间的关系。本应用中提出的研究具有重要意义，因为它将提供与传统的提前护理计划相比，渐进式指导计划有效性的关键数据。研究结果将为POLST表格的进一步修改提供信息，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，并建议改变政策以改善临终关怀。

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.