Reasons for Discordance Between Life-Sustaining Treatment Preferences and Medical Orders in Nursing Facilities Without POLST.
Nicholette L Heim Smith, Rebecca L Sudore, Anne L Myers and 2 others
PMID 36154692WHAT IT FOUND
In nursing facilities without POLST forms, residents and surrogates linked mismatched end-of-life orders to not knowing options, never being asked, preferences not recorded, and family pressure.
Many wanted orders updated after discussing preferences.
Key findings
01Participants attributed discordance between stated end-of-life preferences and existing orders to four themes: inadequate information, no prior discussion, missing documentation, and family involvement.
02After the interview, 13 of 15 residents and 14 of 15 surrogates wanted their life-sustaining treatment orders updated.
03A prominent reason for discordance was that participants had never been asked by facility staff about their life-sustaining treatment preferences.
STILL TO COME
How it was doneWhat they foundWhat it means for RNs
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What it does not show
The study used 15 residents and 15 surrogates from six Indiana facilities, and the sample reflected a predominantly White population, so it may not represent other facilities or communities. Only residents or surrogates were interviewed, not additional family members, friends, or staff, so explanations may be incomplete. Participants were asked to explain discordance after it had been identified, so recall and post-hoc explanations may be biased. Facilities had little use of other life-sustaining treatment orders, such as DNH and DNI, so reasons may differ where those orders are common. This was a qualitative interview study, so it reports participants' explanations rather than testing whether conversations or documentation changes improve concordance.
Declared interests
The authors declared no potential conflicts of interest with respect to the research, authorship, and/or publication of this article.
The easy way to misread this
Do not conclude that POLST forms or staff conversations will reduce discordance. This study only describes residents' and surrogates' explanations in facilities without POLST, and no intervention was tested.