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Susan W Tolle - One of the best experts on this subject based on the ideXlab platform.
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the association of physician orders for Life Sustaining Treatment with intensity of Treatment among patients presenting to the emergency department
Annals of Emergency Medicine, 2020Co-Authors: Susan W Tolle, Dana Zive, Robert Y Lee, Scott D Halpern, Kelly C Vranas, Amber Lin, Christopher G Slatore, Craig D Newgard, Erin K KrossAbstract:Study objective Physician Orders for Life-Sustaining Treatment (POLST) forms are intended to help prevent the provision of unwanted medical interventions among patients with advanced illness or frailty who are approaching the end of Life. We seek to evaluate how POLST form completion, Treatment limitations, or both influence intensity of Treatment among patients who present to the emergency department (ED). Methods This was a retrospective cohort study of adults who presented to the ED at an academic medical center in Oregon between April 2015 and October 2016. POLST form completion and Treatment limitations were the main exposures. Primary outcome was hospital admission; secondary outcomes included ICU admission and a composite measure of aggressive Treatment. Results A total of 26,128 patients were included; 1,769 (6.8%) had completed POLST forms. Among patients with POLST, 52.1% had full Treatment orders, and 6.4% had their forms accessed before admission. POLST form completion was not associated with hospital admission (adjusted odds ratio [aOR]=0.97; 95% confidence interval [CI] 0.84 to 1.12), ICU admission (aOR=0.82; 95% CI 0.55 to 1.22), or aggressive Treatment (aOR=1.06; 95% CI 0.75 to 1.51). Compared with POLST forms with full Treatment orders, those with Treatment limitations were not associated with hospital admission (aOR=1.12; 95% CI 0.92 to 1.37) or aggressive Treatment (aOR=0.87; 95% CI 0.5 to 1.52), but were associated with lower odds of ICU admission (aOR=0.31; 95% CI 0.16 to 0.61). Conclusion Among patients presenting to the ED with POLST, the majority of POLST forms had orders for full Treatment and were not accessed by emergency providers. These findings may partially explain why we found no association of POLST with Treatment intensity. However, Treatment limitations on POLST forms were associated with reduced odds of ICU admission. Implementation and accessibility of POLST forms are crucial when considering their effect on the provision of Treatment consistent with patients’ preferences.
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changes over time in the oregon physician orders for Life Sustaining Treatment registry a study of two decedent cohorts
Journal of Palliative Medicine, 2019Co-Authors: Dana Zive, Erik K Fromme, Valerie M Jimenez, Susan W TolleAbstract:Background: The Physician Orders for Life-Sustaining Treatment (POLST) began in Oregon in 1993 and has since spread nationally and internationally. Objectives: Describe and compare demographics and POLST orders in two decedent cohorts: deaths in 2010-2011 (Cohort 1) and in 2015-2016 (Cohort 2). Design: Descriptive retrospective study. Setting/Subjects: Oregon decedents with an active form in the Oregon POLST Registry. Measurements: Oregon death records were matched with POLST orders. Descriptive analysis and logistic regression models assess differences between the cohorts. Results: The proportion of Oregon decedents with a registered POLST increased by 46.6% from 30.9% (17,902/58,000) in Cohort 1 to 45.3% (29,694/65,458) in Cohort 2. The largest increase (83.3%) was seen in decedents 95 years or older with a corresponding 78.7% increase in those with Alzheimer's disease and dementia, while the interval between POLST form completion and death in these decedents increased from a median of 9-52 weeks. Although orders for do not resuscitate and other orders to limit Treatment remained the most prevalent in both cohorts, logistic regression models confirm a nearly twofold increase in odds for cardiopulmonary resuscitation and full Treatment orders in Cohort 2 when controlling for age, sex, race, education, and cause of death. Conclusion: Compared with Cohort 1, Cohort 2 reflected several trends: a 46.6% increase in POLST Registry utilization most marked in the oldest old, substantial increases in time from POLST completion to death, and disproportionate increases in orders for more aggressive Life-Sustaining Treatment. Based on these findings, we recommend testing new criteria for POLST completion in frail elders.
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association between physician orders for Life Sustaining Treatment for scope of Treatment and in hospital death in oregon
Journal of the American Geriatrics Society, 2014Co-Authors: Erik K Fromme, Dana Zive, Terri A Schmidt, Jennifer N B Cook, Susan W TolleAbstract:OBJECTIVES: To examine the relationship between Physician Orders for Life-Sustaining Treatment (POLST) for Scope of Treatment and setting of care at time of death. DESIGN: Cross-sectional. SETTING: Oregon in 2010 and 2011. PARTICIPANTS: People who died of natural causes. MEASUREMENTS: Oregon death records containing cause and location of death were matched with POLST orders for people with a POLST form in the Oregon POLST registry. Logistic regression was used to measure the association between POLST orders and location of death. RESULTS: Of 58,000 decedents, 17,902 (30.9%) had a POLST form in the registry. Their orders for Scope of Treatment were comfort measure only, 11,836 (66.1%); limited interventions, 4,787 (26.7%); and full Treatment, 1,153 (6.4%). Comfort measures only (CMO) orders advise avoiding hospitalization unless comfort cannot be achieved in the current setting; 6.4% of participants with POLST CMO orders died in the hospital, compared with 44.2% of those with orders for full Treatment and 34.2% for those with no POLST form in the registry. In the logistic regression, the odds of dying in the hospital of those with an order for limited interventions was 3.97 times as great (95% CI = 3.59–4.39) as of those with a CMO order, and the odds of those with an order for full Treatment was 9.66 times as great (95% CI = 8.39–11.13). CONCLUSIONS: The association with numbers of deaths in the hospital suggests that end-of-Life preferences of people who wish to avoid hospitalization as documented in POLST orders are honored. J Am Geriatr Soc 2014.
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physician orders for Life Sustaining Treatment polst lessons learned from analysis of the oregon polst registry
Resuscitation, 2014Co-Authors: Terri A Schmidt, Dana Zive, Erik K Fromme, Jennifer N B Cook, Susan W TolleAbstract:a b s t r a c t Background: Physician Orders for Life-Sustaining Treatment (POLST) has become a common means of documenting patient Treatment preferences. In addition to orders either for Attempt Resuscitation or Do Not Attempt Resuscitation, for patients not in cardiopulmonary arrest, POLST provides three levels of Treatment: Full Treatment, Limited Interventions, and Comfort Measures Only. Oregon has an elec- tronic registry for POLST forms completed in the state. We used registry data to examine the different combinations of Treatment orders. Methods and results: We analyzed data from forms signed and entered into the Oregon POLST Registry in 2012. The analysis included 31,294 POLST forms. The mean Registrant age was 76.7 years. 21,396 (68.4%) had Do Not Attempt Resuscitation (DNR) orders and 9900 (31.6%) had orders for "Attempt Resuscita- tion". The 6 order combinations were: Do Not Resuscitate (DNR)/Comfort Measures Only 10,769 (34.4%), DNR/Limited Interventions 9306 (29.7%), DNR/Full Treatment 1211 (3.9%), Attempt Cardiopulmonary Resuscitation (CPR)/Comfort Measures Only 11 (0.04%), Attempt CPR/Limited Interventions 2281 (7.3%), and Attempt CPR/Full Treatment 7473 (23.9%). Conclusions: The most common order combinations were DNR/Comfort Measures Only, DNR/Limited Interventions and Attempt Resuscitation/Full Treatment. These three makes sense to health professionals. However, other order combinations that require interpretation at the time of a crisis were completed for about 10% of Registrants. These combinations need further investigation. © 2013 Elsevier Ireland Ltd. All rights reserved.
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The Oregon Physician Orders for Life-Sustaining Treatment Registry: A Preliminary Study of Emergency Medical Services Utilization
Journal of Emergency Medicine, 2013Co-Authors: Terri A Schmidt, Dana Zive, Erik K Fromme, Elizabeth A. Olszewski, Susan W TolleAbstract:Abstract Background The Physician Orders for Life-Sustaining Treatment (POLST) form translates patient Treatment preferences into medical orders. The Oregon POLST Registry provides emergency personnel 24-h access to POLST forms. Objective To determine if Emergency Medical Technicians (EMTs) can use the Oregon POLST Registry to honor patient preferences. Methods Two telephone surveys were developed: one for the EMT who made a call to the Registry and one for the patient or the surrogate. The EMT survey was designed to determine if the POLST form accessed through the Registry changed the care of the patient. The patient/surrogate survey was designed to determine if the care provided matched the preferences on the POLST. When feasible, the Emergency Medical Services (EMS) record was reviewed to determine whether or not Treatment was provided. Results During the study period there were 34 EMS calls with matches to patients' POLST forms, and 23 interviews were completed with EMS callers, for a response rate of 68%. In seven cases (30%) the patient was in cardiopulmonary arrest; one patient had a respiratory arrest with a pulse. Eight respondents (35%) reported that the patient was conscious and apparently able to make decisions about preferences. For 10 cases (44%) the POLST orders changed Treatment, and in six instances (26%) they affected the decision to transport the patient. For the 10/11 patients or surrogates interviewed, the care reportedly matched their wishes. Conclusion This small study suggests that an electronic registry of POLST forms can be used by EMTs to enhance their ability to locate and honor patient preferences regarding Life-Sustaining Treatments.
Susan E Hickman - One of the best experts on this subject based on the ideXlab platform.
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do Life Sustaining Treatment orders match patient and surrogate preferences the role of polst
Journal of General Internal Medicine, 2021Co-Authors: Susan E Hickman, Alexia M Torke, Greg A Sachs, Rebecca L Sudore, Qing Tang, Giorgos Bakoyannis, Nicholette Heim SmithAbstract:It is essential to high-quality medical care that Life-Sustaining Treatment orders match the current, values-based preferences of patients or their surrogate decision-makers. It is unknown whether concordance between orders and current preferences is higher when a POLST form is used compared to standard documentation practices. To assess concordance between existing orders and current preferences for nursing facility residents with and without POLST forms. Chart review and interviews. Forty Indiana nursing facilities (29 where POLST is used and 11 where POLST is not in use). One hundred sixty-one residents able to provide consent and 197 surrogate decision-makers of incapacitated residents with and without POLST forms. Concordance was measured by comparing Life-Sustaining Treatment orders in the medical record (e.g., orders about resuscitation, intubation, and hospitalization) with current preferences. Concordance was analyzed using population-averaged binary logistic regression. Inverse probability weighting techniques were used to account for non-response. We hypothesized that concordance would be higher in residents with POLST (n = 275) in comparison to residents without POLST (n = 83). Concordance was higher for residents with POLST than without POLST (59.3% versus 34.9%). In a model adjusted for resident, surrogate, and facility characteristics, the odds were 3.05 times higher that residents with POLST had orders for Life-Sustaining Treatment match current preferences in comparison to residents without POLST (OR 3.05 95% CI 1.67–5.58, p < 0.001). No other variables were significantly associated with concordance. Nursing facility residents with POLST are significantly more likely than residents without POLST to have concordance between orders in their medical records and current preferences for Life-Sustaining Treatments, increasing the likelihood that their Treatment preferences will be known and honored. However, findings indicate further systems change and clinical training are needed to improve POLST concordance.
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a tool to assess patient and surrogate knowledge about the polst physician orders for Life Sustaining Treatment program
Journal of Pain and Symptom Management, 2019Co-Authors: Susan E Hickman, Alexia M Torke, Greg A Sachs, Rebecca L SudoreAbstract:Abstract Context It is especially important that patients are well informed when making high-stakes, preference-sensitive decisions like those on the Physician Orders for Life-Sustaining Treatment (POLST) form. However, there is currently no way to easily evaluate whether patients understand key concepts when making these important decisions. Objectives To develop a POLST knowledge survey. Methods Expert (n = 62) ratings of key POLST facts were used to select items for a POLST knowledge survey. The survey was administered to nursing facility residents (n = 97) and surrogate decision-makers (n = 112). A subset (n = 135) were re-administered the survey after a standardized advance care planning discussion to assess the scale's responsiveness to change. Results The 19-item survey demonstrated adequate reliability (α = 0.72.). Residents' scores (x = 11.4, standard deviation 3.3) were significantly lower than surrogate scores (x = 14.7, standard deviation 2.5) (P Conclusion The 19-item POLST Knowledge Survey demonstrated adequate reliability and responsiveness to change. Findings suggest the survey could be used to identify knowledge deficits and provide targeted education to ensure adequate understanding of key clinical decisions when completing POLST.
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the quality of physician orders for Life Sustaining Treatment decisions a pilot study
Journal of Palliative Medicine, 2017Co-Authors: Susan E Hickman, Bernard J Hammes, Alexia M Torke, Rebecca L Sudore, Greg A SachsAbstract:Abstract Background: Physician Orders for Life-Sustaining Treatment (POLST) forms are used to document patient Treatment preferences as medical orders. Prior research demonstrates that use of POLST alters medical Treatments in a way that is consistent with the POLST orders. However, there are minimal data about the quality of POLST decisions, including whether they reflect the current preferences of well-informed patients. Objective: Evaluate the quality of POLST decisions. Design: Chart abstraction; interviews. Subjects: Nursing home residents and healthcare agents of incapacitated nursing home residents (n = 28). Measurements: Characteristics of the POLST conversation were assessed. Brief vignettes were used to assess knowledge about how POLST orders guide medical Treatment. Current Treatment preferences were elicited and compared with the patient's POLST orders to assess discordance. Results: A majority (59%) of participants recognized the POLST form. Participants were generally accurate in their knowl...
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use of the physician orders for Life Sustaining Treatment program in the clinical setting a systematic review of the literature
Other, 2015Co-Authors: Susan E Hickman, Elisabeth Keevern, Bernard J HammesAbstract:The Physician Orders for Life-Sustaining Treatment (POLST) form is a palliative care tool that contains standardized, actionable medical orders. It is designed to ensure that patient Treatment preferences are elicited, communicated, and honored throughout the healthcare system. A systematic review of the literature was conducted to evaluate what is currently known about the POLST program and identify directions for future research. Twenty-three research studies focused on POLST use in the clinical setting were identified. A majority of studies have been conducted all or in part in Oregon, with chart review the most frequently used methodology. Research suggests that POLST is most commonly used in older, white patients who are near the end of Life. A nonphysician facilitator usually prepares the POLST form for the physician to review and sign. The orders documented on POLST reflect a wide degree of individualization, with only approximately one-third of patients having orders reflecting the lowest level of Treatment in all POLST form sections. Clinicians have generally positive attitudes regarding use of POLST yet report a wide range of challenges. POLST alters Treatment in a way that is consistent with orders. However, evidence that POLST reflects patient or surrogate Treatment preferences is lacking. Research is needed to evaluate the quality of POLST decisions, explore the experiences of patients and their surrogates, develop decision-support tools, improve clinician education, and assess the effect of POLST on care outcomes through intervention and population-based studies.
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use of the physician orders for Life Sustaining Treatment program for patients being discharged from the hospital to the nursing facility
Journal of Palliative Medicine, 2014Co-Authors: Susan E Hickman, Christine C Nelson, Esther Smithhowell, Bernard J HammesAbstract:Abstract Background: The Physician Orders for Life-Sustaining Treatment (POLST) documents patient preferences as medical orders that transfer across settings with patients. Objectives: The objectives were to pilot test methods and gather preliminary data about POLST including (1) use at time of hospital discharge, (2) transfers across settings, and (3) consistency with prior decisions. Study Design: Descriptive with chart abstraction and interviews. Participants: Participants were hospitalized patients discharged to a nursing facility and/or their surrogates in La Crosse County, Wisconsin. Measurements: POLST forms were abstracted from hospital records for 151 patients. Hospital and nursing facility chart data were abstracted and interviews were conducted with an additional 39 patients/surrogates. Results: Overall, 176 patients had valid POLST forms at the time of discharge from the hospital, and many (38.6%; 68/176) only documented code status. When the whole POLST was completed, orders were more often m...
Malcolm Parker - One of the best experts on this subject based on the ideXlab platform.
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the role of law in decisions to withhold and withdraw Life Sustaining Treatment from adults who lack capacity a cross sectional study
Social Science Research Network, 2016Co-Authors: Benjamin P White, Lindy Willmott, Colleen M Cartwright, Gail M Williams, Malcolm ParkerAbstract:Objectives: To determine the role played by law in medical specialists’ decision-making about withholding and withdrawing Life-Sustaining Treatment (WWLST) from adults who lack capacity, and the extent to which legal knowledge affects whether law is followed. Design: Cross-sectional postal survey of medical specialists. Setting: The two largest Australian states by population. Participants: 649 medical specialists from seven specialties most likely to be involved in end-of-Life decision-making in the acute setting. Main outcome measures: Compliance with law and the impact of legal knowledge on compliance. Results: 649 medical specialists (of 2104 potential participants) completed the survey (response rate 31%). Responses to a hypothetical scenario found a potential low rate of legal compliance, 32% (95% CI 28% to 36%). Knowledge of the law and legal compliance were associated: within compliers, 86% (95% CI 83% to 91%) had specific knowledge of the relevant aspect of the law, compared to 60% (95% CI 55% to 65%) within non-compliers. However, the reasons medical specialists gave for making decisions did not vary according to legal knowledge. Conclusions: Medical specialists prioritise patient-related clinical factors over law when confronted with a scenario where legal compliance is inconsistent with what they believe is clinically indicated. Although legally knowledgeable specialists were more likely to comply with the law, compliance in the scenario was not motivated by an intention to follow law. Ethical considerations (which are different from, but often align with, law) are suggested as a more important influence in clinical decision-making. More education and training of doctors is needed to demonstrate the role, relevance and utility of law in end-of-Life care.
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doctors perspectives on law and Life Sustaining Treatment survey design and recruitment strategies for a challenging cohort
Progress in Palliative Care, 2016Co-Authors: Lindy Willmott, Benjamin P White, Colleen M Cartwright, Malcolm Parker, Gail M Williams, Penny NellerAbstract:Background: Palliative medicine and other specialists play significant legal roles in decisions to withhold and withdraw Life-Sustaining Treatment at the end of Life. Yet little is known about their knowledge of or attitudes to the law, and the role they think it should play in medical practice. Consideration of doctors’ views is critical to optimizing patient outcomes at the end of Life. However, doctors are difficult to engage as participants in empirical research, presenting challenges for researchers seeking to understand doctors’ experiences and perspectives.Aims: To determine how to engage doctors involved in end-of-Life care in empirical research about knowledge of the law and the role it plays in medical practice at the end of Life.Methods: Postal survey of all specialists in palliative medicine, emergency medicine, geriatric medicine, intensive care, medical oncology, renal medicine, and respiratory medicine in three Australian states: New South Wales, Victoria, and Queensland. The survey was sen...
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palliative care and other physicians knowledge attitudes and practice relating to the law on withholding withdrawing Life Sustaining Treatment survey results
Palliative Medicine, 2016Co-Authors: Colleen M Cartwright, Lindy Willmott, Ben White, Gail M Williams, Malcolm ParkerAbstract:Background:To effectively care for people who are terminally ill, including those without decision-making capacity, palliative care physicians must know and understand the legal standing of Advance Care Planning in their jurisdiction of practice. This includes the use of advance directives/living wills and substitute decision-makers who can legally consent to or refuse Treatment if there is no valid advance directive.Aim:This study aimed to investigate the knowledge, attitudes and practices of medical specialists most often involved in end-of-Life care in relation to the law on withholding/withdrawing Life-Sustaining Treatment from adults without decision-making capacity.Design/participants:A pre-piloted survey was posted to specialists in palliative, emergency, geriatric, renal and respiratory medicine; intensive care; and medical oncology in three Australian States. Surveys were analysed using SPSS 20 and SAS 9.3.Results:The overall response rate was 32% (867/2702) – 52% from palliative care specialists...
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the knowledge and practice of doctors in relation to the law that governs withholding and withdrawing Life Sustaining Treatment from adults who lack capacity
Social Science Research Network, 2016Co-Authors: Benjamin P White, Lindy Willmott, Colleen M Cartwright, Malcolm Parker, Gail M WilliamsAbstract:Law establishes a framework for making decisions about withholding and withdrawing Life-Sustaining Treatment from adults who lack capacity. However, to what extent do doctors know and follow this law? This article reports on a three-year empirical study that sought to answer these questions. The research found that doctors have significant legal knowledge gaps in this area. It also found that doctors do not attach significant weight to legal considerations in their decision-making. This article argues that law does have a role to play in end-of-Life care. However, law reform is needed to make the law more accessible, medical education needs to be improved, and a change in attitude by doctors to medical law is required.
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doctors perspectives on law and Life Sustaining Treatment survey design and recruitment strategies for a challenging cohort
Social Science Research Network, 2016Co-Authors: Lindy Willmott, Benjamin P White, Colleen M Cartwright, Malcolm Parker, Gail M Williams, Penny NellerAbstract:Background: Palliative medicine and other specialists play significant legal roles in decisions to withhold and withdraw Life-Sustaining Treatment at the end of Life. Yet little is known about their knowledge of or attitudes to the law, and the role they think it should play in medical practice. Consideration of doctors’ views is critical to optimizing patient outcomes at the end of Life. However, doctors are difficult to engage as participants in empirical research, presenting challenges for researchers seeking to understand doctors’ experiences and perspectives. Aims: To determine how to engage doctors involved in end-of-Life care in empirical research about knowledge of the law and the role it plays in medical practice at the end of Life. Methods: Postal survey of all specialists in palliative medicine, emergency medicine, geriatric medicine, intensive care, medical oncology, renal medicine, and respiratory medicine in three Australian states: New South Wales, Victoria, and Queensland. The survey was sent in hard copy with two reminders and a follow up reminder letter was also sent to the directors of hospital emergency departments. Awareness was further promoted through engagement with the relevant medical colleges and publications in professional journals; various incentives to respond were also used. The key measure is the response rate of doctors to the survey. Results: Thirty-two percent of doctors in the main study completed their survey with response rate by specialty ranging from 52% (palliative care) to 24% (medical oncology). This overall response rate was twice that of the re-weighted pilot study (16%). Conclusions: Doctors remain a difficult cohort to engage in survey research but strategic recruitment efforts can be effective in increasing response rate. Collaboration with doctors and their professional bodies in both the development of the survey instrument and recruitment of participants is essential.
Lindy Willmott - One of the best experts on this subject based on the ideXlab platform.
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next up a proposal for values based law reform on unilateral withholding and withdrawal of potentially Life Sustaining Treatment
Alberta law review, 2017Co-Authors: Jocelyn Downie, Lindy Willmott, Benjamin P WhiteAbstract:The unilateral withholding and withdrawal of potentially Life-Sustaining Treatment presents a complex issue of law and public policy. The authors examine the current state of this practice and conclude that it is occurring, being challenged in the courts, and is treated differently in different jurisdictions. The authors review the current state of the law in the United Kingdom, Australia, New Zealand, the United States, and Canada. The authors use Canada as a case study to outline a process for pursuing law reform. The authors propose a model for law and policy reform in this area that is both informed and shaped by the fundamental values of Canadian society.
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the role of law in decisions to withhold and withdraw Life Sustaining Treatment from adults who lack capacity a cross sectional study
Social Science Research Network, 2016Co-Authors: Benjamin P White, Lindy Willmott, Colleen M Cartwright, Gail M Williams, Malcolm ParkerAbstract:Objectives: To determine the role played by law in medical specialists’ decision-making about withholding and withdrawing Life-Sustaining Treatment (WWLST) from adults who lack capacity, and the extent to which legal knowledge affects whether law is followed. Design: Cross-sectional postal survey of medical specialists. Setting: The two largest Australian states by population. Participants: 649 medical specialists from seven specialties most likely to be involved in end-of-Life decision-making in the acute setting. Main outcome measures: Compliance with law and the impact of legal knowledge on compliance. Results: 649 medical specialists (of 2104 potential participants) completed the survey (response rate 31%). Responses to a hypothetical scenario found a potential low rate of legal compliance, 32% (95% CI 28% to 36%). Knowledge of the law and legal compliance were associated: within compliers, 86% (95% CI 83% to 91%) had specific knowledge of the relevant aspect of the law, compared to 60% (95% CI 55% to 65%) within non-compliers. However, the reasons medical specialists gave for making decisions did not vary according to legal knowledge. Conclusions: Medical specialists prioritise patient-related clinical factors over law when confronted with a scenario where legal compliance is inconsistent with what they believe is clinically indicated. Although legally knowledgeable specialists were more likely to comply with the law, compliance in the scenario was not motivated by an intention to follow law. Ethical considerations (which are different from, but often align with, law) are suggested as a more important influence in clinical decision-making. More education and training of doctors is needed to demonstrate the role, relevance and utility of law in end-of-Life care.
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doctors perspectives on law and Life Sustaining Treatment survey design and recruitment strategies for a challenging cohort
Progress in Palliative Care, 2016Co-Authors: Lindy Willmott, Benjamin P White, Colleen M Cartwright, Malcolm Parker, Gail M Williams, Penny NellerAbstract:Background: Palliative medicine and other specialists play significant legal roles in decisions to withhold and withdraw Life-Sustaining Treatment at the end of Life. Yet little is known about their knowledge of or attitudes to the law, and the role they think it should play in medical practice. Consideration of doctors’ views is critical to optimizing patient outcomes at the end of Life. However, doctors are difficult to engage as participants in empirical research, presenting challenges for researchers seeking to understand doctors’ experiences and perspectives.Aims: To determine how to engage doctors involved in end-of-Life care in empirical research about knowledge of the law and the role it plays in medical practice at the end of Life.Methods: Postal survey of all specialists in palliative medicine, emergency medicine, geriatric medicine, intensive care, medical oncology, renal medicine, and respiratory medicine in three Australian states: New South Wales, Victoria, and Queensland. The survey was sen...
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palliative care and other physicians knowledge attitudes and practice relating to the law on withholding withdrawing Life Sustaining Treatment survey results
Palliative Medicine, 2016Co-Authors: Colleen M Cartwright, Lindy Willmott, Ben White, Gail M Williams, Malcolm ParkerAbstract:Background:To effectively care for people who are terminally ill, including those without decision-making capacity, palliative care physicians must know and understand the legal standing of Advance Care Planning in their jurisdiction of practice. This includes the use of advance directives/living wills and substitute decision-makers who can legally consent to or refuse Treatment if there is no valid advance directive.Aim:This study aimed to investigate the knowledge, attitudes and practices of medical specialists most often involved in end-of-Life care in relation to the law on withholding/withdrawing Life-Sustaining Treatment from adults without decision-making capacity.Design/participants:A pre-piloted survey was posted to specialists in palliative, emergency, geriatric, renal and respiratory medicine; intensive care; and medical oncology in three Australian States. Surveys were analysed using SPSS 20 and SAS 9.3.Results:The overall response rate was 32% (867/2702) – 52% from palliative care specialists...
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the knowledge and practice of doctors in relation to the law that governs withholding and withdrawing Life Sustaining Treatment from adults who lack capacity
Social Science Research Network, 2016Co-Authors: Benjamin P White, Lindy Willmott, Colleen M Cartwright, Malcolm Parker, Gail M WilliamsAbstract:Law establishes a framework for making decisions about withholding and withdrawing Life-Sustaining Treatment from adults who lack capacity. However, to what extent do doctors know and follow this law? This article reports on a three-year empirical study that sought to answer these questions. The research found that doctors have significant legal knowledge gaps in this area. It also found that doctors do not attach significant weight to legal considerations in their decision-making. This article argues that law does have a role to play in end-of-Life care. However, law reform is needed to make the law more accessible, medical education needs to be improved, and a change in attitude by doctors to medical law is required.
Bernard J Hammes - One of the best experts on this subject based on the ideXlab platform.
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the quality of physician orders for Life Sustaining Treatment decisions a pilot study
Journal of Palliative Medicine, 2017Co-Authors: Susan E Hickman, Bernard J Hammes, Alexia M Torke, Rebecca L Sudore, Greg A SachsAbstract:Abstract Background: Physician Orders for Life-Sustaining Treatment (POLST) forms are used to document patient Treatment preferences as medical orders. Prior research demonstrates that use of POLST alters medical Treatments in a way that is consistent with the POLST orders. However, there are minimal data about the quality of POLST decisions, including whether they reflect the current preferences of well-informed patients. Objective: Evaluate the quality of POLST decisions. Design: Chart abstraction; interviews. Subjects: Nursing home residents and healthcare agents of incapacitated nursing home residents (n = 28). Measurements: Characteristics of the POLST conversation were assessed. Brief vignettes were used to assess knowledge about how POLST orders guide medical Treatment. Current Treatment preferences were elicited and compared with the patient's POLST orders to assess discordance. Results: A majority (59%) of participants recognized the POLST form. Participants were generally accurate in their knowl...
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use of the physician orders for Life Sustaining Treatment program in the clinical setting a systematic review of the literature
Other, 2015Co-Authors: Susan E Hickman, Elisabeth Keevern, Bernard J HammesAbstract:The Physician Orders for Life-Sustaining Treatment (POLST) form is a palliative care tool that contains standardized, actionable medical orders. It is designed to ensure that patient Treatment preferences are elicited, communicated, and honored throughout the healthcare system. A systematic review of the literature was conducted to evaluate what is currently known about the POLST program and identify directions for future research. Twenty-three research studies focused on POLST use in the clinical setting were identified. A majority of studies have been conducted all or in part in Oregon, with chart review the most frequently used methodology. Research suggests that POLST is most commonly used in older, white patients who are near the end of Life. A nonphysician facilitator usually prepares the POLST form for the physician to review and sign. The orders documented on POLST reflect a wide degree of individualization, with only approximately one-third of patients having orders reflecting the lowest level of Treatment in all POLST form sections. Clinicians have generally positive attitudes regarding use of POLST yet report a wide range of challenges. POLST alters Treatment in a way that is consistent with orders. However, evidence that POLST reflects patient or surrogate Treatment preferences is lacking. Research is needed to evaluate the quality of POLST decisions, explore the experiences of patients and their surrogates, develop decision-support tools, improve clinician education, and assess the effect of POLST on care outcomes through intervention and population-based studies.
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use of the physician orders for Life Sustaining Treatment program for patients being discharged from the hospital to the nursing facility
Journal of Palliative Medicine, 2014Co-Authors: Susan E Hickman, Christine C Nelson, Esther Smithhowell, Bernard J HammesAbstract:Abstract Background: The Physician Orders for Life-Sustaining Treatment (POLST) documents patient preferences as medical orders that transfer across settings with patients. Objectives: The objectives were to pilot test methods and gather preliminary data about POLST including (1) use at time of hospital discharge, (2) transfers across settings, and (3) consistency with prior decisions. Study Design: Descriptive with chart abstraction and interviews. Participants: Participants were hospitalized patients discharged to a nursing facility and/or their surrogates in La Crosse County, Wisconsin. Measurements: POLST forms were abstracted from hospital records for 151 patients. Hospital and nursing facility chart data were abstracted and interviews were conducted with an additional 39 patients/surrogates. Results: Overall, 176 patients had valid POLST forms at the time of discharge from the hospital, and many (38.6%; 68/176) only documented code status. When the whole POLST was completed, orders were more often m...
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the consistency between Treatments provided to nursing facility residents and orders on the physician orders for Life Sustaining Treatment form
Journal of the American Geriatrics Society, 2011Co-Authors: Susan E Hickman, Alvin H Moss, Susan W Tolle, R Christine N A Nelson, Nancy Perrin, Bernard J HammesAbstract:Objectives To evaluate the consistency between Treatments provided and Physician Orders for Life-Sustaining Treatment (POLST) orders. Design Retrospective chart abstraction. Setting Stratified, random sample of 90 nursing facilities in Oregon, Wisconsin, and West Virginia. Participants Eight hundred seventy living and deceased nursing facility residents aged 65 and older with a minimum 60-day stay. Measurements Chart data about POLST form orders and related Treatments over a 60-day period were abstracted. Decision rules were created to determine whether the rationale for each Treatment was consistent with POLST orders. Results Most residents (85.2%) had the same POLST form in place during the review period. A majority of Treatments provided to residents with orders for comfort measures only (74.3%) and limited antibiotics (83.3%) were consistent with POLST orders because they were primarily comfort focused rather than Life-prolonging, but antibiotics were provided to 32.1% of residents with orders for no antibiotics. Overall consistency rates between Treatments and POLST orders were high for resuscitation (98%), medical interventions (91.1%), and antibiotics (92.9%) and modest for feeding tubes (63.6%). In all, POLST orders were consistent with Treatments provided 94.0% of the time. Conclusion With the exception of feeding tubes and antibiotic use in residents with orders for no antibiotics, the use of medical Treatments was nearly always consistent with POLST orders to provide or withhold Life-Sustaining interventions. The POLST program is a useful tool for ensuring that the Treatment preferences of nursing facility residents are honored.
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A comparison of methods to communicate Treatment preferences in nursing facilities: Traditional practices versus the physician orders for Life-Sustaining Treatment program
Journal of the American Geriatrics Society, 2010Co-Authors: Susan E Hickman, Alvin H Moss, Bernard J Hammes, Nancy A Perrin, Rn Christine A. Nelson, Susan W TolleAbstract:OBJECTIVES: To evaluate the relationship between two methods to communicate Treatment preferences (Physician Orders for Life-Sustaining Treatment (POLST) program vs traditional practices) and documentation of Life-Sustaining Treatment orders, symptom assessment and management, and use of Life-Sustaining Treatments. DESIGN: Retrospective observational cohort study conducted between June 2006 and April 2007. SETTING: A stratified, random sample of 90 Medicaideligible nursing facilities in Oregon, Wisconsin, and West Virginia. PARTICIPANTS: One thousand seven hundred eleven living and deceased nursing facility residents aged 65 and older with a minimum 60-day stay. MEASUREMENTS: Life-Sustaining Treatment orders; pain, shortness of breath, and related Treatments over a 7day period; and use of Life-Sustaining Treatments over a 60day period. RESULTS: Residents with POLST forms were more likely to have orders about Life-Sustaining Treatment preferences beyond cardiopulmonary resuscitation than residents without (98.0% vs 16.1%, Po.001). There were no differences between residents with and without POLST forms in symptom assessment or management. Residents with POLST forms indicating orders for comfort measures only were less likely to receive medical interventions (e.g., hospitalization) than residents with POLST full Treatment orders (P 5.004), residents with traditional do-not-resuscitate orders (Po.001), or residents with traditional full code orders (Po.001). CONCLUSION: Residents with POLST forms were more likely to have Treatment preferences documented as medical orders than those who did not, but there were no differences in symptom management or assessment. POLST orders restricting medical interventions were associated with less use of Life-Sustaining Treatments. Findings suggest that the POLST program offers significant advantages over traditional methods to communicate preferences about Life-Sustaining Treatments. J Am Geriatr Soc 58:1241–1248, 2010.