Publications by authors named "Nicholette Heim Smith"
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.
Background: Life-sustaining treatment (LST) orders are important communication tools used to ensure preference-concordant care at the end of life. Recent studies reveal concerning rates of discordance between current preferences and documented LST orders, especially in nursing facilities without POLST. Reasons for discordance in facilities using POLST have been explored, however the majority of nursing facilities in the United States do not yet use the POLST form.
View Article and Find Full Text PDFBackground: POLST is widely used to document the treatment preferences of nursing facility residents as orders, but it is unknown how well previously completed POLST orders reflect current preferences (concordance) and what factors are associated with concordance.
Objectives: To describe POLST preference concordance and identify factors associated with concordance.
Design: Chart reviews to document existing POLST orders and interviews to elicit current treatment preferences.
Background: The reasons for discordance between advance care planning (ACP) documentation and current preferences are not well understood. The POLST form offers a unique opportunity to learn about the reasons for discordance and concordance that has relevance for POLST as well as ACP generally.
Design: Qualitative descriptive including constant comparative analysis within and across cases.
Article Synopsis
- - The study investigates whether life-sustaining treatment orders align better with patient preferences in nursing facility residents using POLST (Physician Orders for Life-Sustaining Treatment) forms compared to those without these forms.
- - Results indicate that residents with POLST forms have a significantly higher concordance rate (59.3%) between treatment orders and their current preferences than those without (34.9%).
- - The odds of having matching orders are over three times greater for residents with POLST, highlighting the effectiveness of POLST in ensuring patients' wishes are respected in medical care decisions.