Converting Treatment Wishes into Orders at End of Life

描述（由申请人提供）：传统的预先指示被认为是通过提供治疗偏好的文件以促进决策来改善护理机构居民的临终护理的一种手段。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（医生维持生命治疗订单）计划的核心是一个渐进的指令文件，引起了全国各地寻求改善临终关怀的社区的注意。POLST表已被纳入实践中，尽管在整个美国的最低限度的数据有关的有效性，这一计划。将进行POLST计划的多中心研究，以便：1）比较POLST计划与传统的预先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POLST表与传统预先护理计划对护理机构居民使用特定生命维持治疗的情况;以及4）评估POLST计划的设施使用是否与来自国家数据集的寿命结束指标的差异相关。俄勒冈州、威斯康星州和西弗吉尼亚州的护理机构将接受电话调查，以评估提前规划的做法和POLST计划的使用情况。接下来，图表审查将在每个州的大约30个护理机构进行，以获得1800个带有和不带POLST表格的图表样本。还将获得联邦数据，以评估POLST计划使用、医疗保险和最小数据集寿命终了变量之间的关系。本申请中提出的研究是重要的，因为它将提供与传统的提前护理计划相比，渐进式指导计划的有效性的关键数据。研究结果将为POLST表格的进一步修改提供信息，指导教育计划的制定，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.