POLST recall, concordance, and decision quality outcomes among nursing home residents and surrogate decision-makers

Susan E Hickman; Rebecca L Sudore; Alexia M Torke; Qing Tang; Giorgos Bakoyannis; Nicholette Heim Smith; Anne L Myers; Bernard J Hammes

doi:10.1111/jgs.18330

POLST recall, concordance, and decision quality outcomes among nursing home residents and surrogate decision-makers

J Am Geriatr Soc. 2023 Jul;71(7):2271-2278. doi: 10.1111/jgs.18330. Epub 2023 Mar 16.

Authors

Susan E Hickman^{1

2

3

4}, Rebecca L Sudore⁵, Alexia M Torke^{2

3

4}, Qing Tang^{6

7}, Giorgos Bakoyannis^{6

7}, Nicholette Heim Smith¹, Anne L Myers¹, Bernard J Hammes⁸

Affiliations

¹ Department of Community & Health Systems, Indiana University School of Nursing, Indianapolis, Indiana, USA.
² Research in Palliative and End-of-Life Communication & Training (RESPECT) Signature Center, Indiana University Purdue University Indianapolis, Indianapolis, Indiana, USA.
³ Division of General Internal Medicine & Geriatrics, Indiana University School of Medicine, Indianapolis, Indiana, USA.
⁴ Indiana University Center for Aging Research, Regenstrief Institute, Inc., Indianapolis, Indiana, USA.
⁵ Division of Geriatrics, School of Medicine, University of California San Francisco, San Francisco, California, USA.
⁶ Department of Biostatistics, Indiana University School of Medicine, Indianapolis, Indiana, USA.
⁷ Fairbanks School of Public Health, Indiana University, Indianapolis, Indiana, USA.
⁸ Respecting Choices, A Division of C-TAC Innovations, La Crosse, Wisconsin, USA.

PMID: 36929327
DOI: 10.1111/jgs.18330

Abstract

Background: POLST orders are actionable in an emergency, so it is important that the decisions be of high quality and concordant with current preferences. The goal of this study is to determine the relationship between concordance and decision quality outcomes, including decision satisfaction and decisional conflict, among nursing facility residents and surrogates who recall POLST.

Methods: We completed structured interviews in 29 nursing facilities with 275 participants who had previously signed a POLST form. This included residents who were still making their own medical decisions (n = 123) and surrogate decision-makers for residents without decisional capacity (n = 152). POLST recall was defined as remembering talking about and/or completing the POLST form previously signed by the participant. Concordance was determined by comparing preferences elicited during a standardized interview with the POLST form on file. Decisional conflict, decision satisfaction, and conversation quality were assessed with standardized tools.

Results: Half of participants (50%) remembered talking about or completing the POLST form, but recall was not associated with the length of time since POLST completion or concordance with existing preferences. In multivariable analyses, there was no association between POLST recall, concordance, and decision quality outcomes, though satisfaction was associated with conversation quality.

Conclusions: Half of the residents and surrogates in this study recalled the POLST they previously signed. Neither the age of the form nor the ability to recall the POLST conversation should be considered indicators of whether existing POLST orders match current preferences. Findings confirm a relationship between POLST conversation quality and satisfaction, underscoring the importance of POLST completion as a communication process.

Keywords: advance care planning; nursing home; palliative care.

Publication types

Research Support, N.I.H., Extramural

MeSH terms

Advance Care Planning*
Decision Making
Humans
Nursing Homes
Patient Preference
Resuscitation Orders*