scholarly journals The Pearls of Physician Orders for Life Sustaining Treatment (POLST): Translating Patient Decisions into Treatment Orders

2019 ◽  
Vol 25 (1) ◽  
Author(s):  
Nancy Joyner ◽  
Carol Palmer ◽  
Joanne Hatchett
Keyword(s):  
Advance Directives ◽  
Advance Care Planning ◽  
The United States ◽  
Individual Treatment ◽  
Advanced Practice ◽  
Care Planning ◽  
Practice Nurses ◽  
Patient Status ◽  
Life Sustaining Treatment ◽  
Advance Care

Since the Physician Orders for Life Sustaining Treatment (POLST) Paradigm began in 1991, POLST has become utilized throughout the United States. POLST includes the national POLST Paradigm as well as state and regional programs and their specific POLST orders. Yet many nurses may not have received the education needed for POLST implementation. This article seeks to honor individual preferences through advance care planning (ACP) by providing an understanding of POLST, which documents individual treatment wishes as medical orders. In the article the authors discuss advance care planning, advance directives, changes in patient status, and the inception and description of POLST. They distinguish POLST from DNR orders, compare POLST to advance directives, and describe the roles of registered and advanced practice nurses. Additionally, they consider studies that have endorsed the POLST paradigm, and share POLST paradigm pearls as well as possible paradigm pitfalls.

Advance directives and advance care planning

2018 ◽  
Author(s):  
Maria J. Silveira ◽  
Phillip Rodgers
Keyword(s):  
Advance Directives ◽  
Advance Care Planning ◽  
The United States ◽  
Evidence Base ◽  
Care Planning ◽  
Exponential Increase ◽  
Use Of Technology ◽  
The Us ◽  
History Of ◽  
Advance Care

This chapter discusses the history of advance directives (ADs) and Advance Care Planning (ACP) in the United States of America, the evidence base regarding the application of ADs and ACP in American healthcare, and the use of technology to facilitate ACP and AD in the US. Improvements in public health and biomedical technology during the latter half of the twentieth century substantially extended life expectancy in the US from 47 in 1900 to 79 by 2014. This accomplishment paired with the aging of America’s largest generation (know fondly as the ‘baby boomers’), is largely responsible for an exponential increase in expenditures related to healthcare over the last 20 years.

scholarly journals IMPACT OF GERIATRIC INTERPROFESSIONAL TRAINING ON ADVANCE CARE PLANNING IN GERIATRIC PRIMARY CARE

2019 ◽  
Vol 3 (Supplement_1) ◽  
pp. S151-S152
Author(s):  
Maureen E Barrientos ◽  
Anna Chodos ◽  
Alicia Neumann ◽  
Yvonne Troya ◽  
Pei Chen
Keyword(s):  
Primary Care ◽  
Social Work ◽  
Advance Care Planning ◽  
Health Resources ◽  
The United States ◽  
Care Practice ◽  
Care Planning ◽  
Office Visits ◽  
Advance Care ◽  
Telephone Calls

Abstract Currently, an important measure of Advance Care Planning (ACP), Advance Health Care Directives (AHCD) documentation rate, is at 33% for older adults in the United States. To address this disparity, geriatric faculty in an academic geriatric primary care practice aimed to train geriatrics fellows and other interprofessional (IP) learners to engage patients in ACP. As part of a Geriatric Workforce Enhancement Program funded by the Health Resources and Services Administration, geriatrics faculty and the Medical Legal Partnership for Seniors based at University of California Hastings College of Law provided ACP training to fellows and IP learners, including social work interns. In practice, the fellows and social work interns collaborated to incorporate ACP into patient visits and follow-up telephone calls. To monitor ACP progress, research staff reviewed patients’ electronic health records and performed descriptive analysis of the data. In 21 months, 4 geriatrics fellows built a panel of 59 patients who on average had 3 office visits and 7 telephone calls per person. Prior to clinic enrollment, 12 (20.3%) patients had preexisting AHCD, and 47 lacked AHCD documentation. After ACP intervention, 42 of 47 patients without AHCD documentation engaged in ACP discussion. Of those who engaged in ACP discussion, 24 completed AHCD, raising AHCD completion rate to 61%, or 36 patients in the panel of 59. ACP is a complex process that benefits from skilled communication among interprofessional providers and patients. Findings underscore the potential advantages of IP training and engaging patients in ACP discussion in an academic primary care setting.

Decision-Making Toolkit

2021 ◽  
pp. 60-76
Author(s):  
Jeffrey D. Myers
Keyword(s):  
Decision Making ◽  
Advance Directives ◽  
Advance Care Planning ◽  
Physician Assistant ◽  
Healthcare Providers ◽  
Terminally Ill ◽  
Decision Makers ◽  
Care Planning ◽  
Collaborative Partnership ◽  
Advance Care

Physician assistant (PA) training is rooted in treating the whole patient and developing a trusting and collaborative partnership with patients and their families. This foundation is critical in the advance care planning (ACP) process for patients who are seriously or terminally ill. Understanding the ACP process, the components and reasons behind them, and the tools for successful discussions and decision-making is a key skill set for all healthcare providers, including PAs. This chapter examines the components of ACP, including advance directives, the POLST paradigm, decision-makers, prognostication, documentation, and legacy planning. ACP is key in capturing what is most important to our patients in terms of their health, their life, and their goals related to both.

scholarly journals Identifying barriers and facilitators to implementing advance care planning in prisons: a rapid literature review

2020 ◽  
Vol 8 (1) ◽  
Author(s):  
Ashley Macleod ◽  
Divya Nair ◽  
Ekin Ilbahar ◽  
Marcus Sellars ◽  
Linda Nolte
Keyword(s):  
Advance Care Planning ◽  
The United States ◽  
Barriers And Facilitators ◽  
System Level ◽  
Ageing Population ◽  
Care Planning ◽  
Limited Information ◽  
Correctional Setting ◽  
Academic Literature ◽  
Advance Care

Abstract Background Limited information is available describing advance care planning (ACP) within correctional facilities, despite its increasing relevance due to the ageing population in prisons and the high rates of complex medical comorbidities. In Western countries, self-determination with respect to making future medical decisions is a human right that prisoners do not lose when they are remanded into custody. ACP enables individuals to plan for their health and personal care so their values, beliefs and preferences are made known to inform future decision-making, for a time when they can no longer communicate their decisions. This paper examines the limited academic literature relating to ACP within prisons to identify barriers and facilitators that influence the uptake of ACP and advance care directive (ACD) documentation. Common themes related to ACP in a correctional setting were extracted and synthesised to produce a high-level analysis of barriers and facilitators influencing ACP uptake for prisoners within a correctional setting. Results Six articles met the selection criteria and reported on the experience of ACP and ACDs in prisons; five from the United States of America and one from Switzerland. Three dominant themes were identified, with related subthemes: system-level factors, attitudes and perceptions, and ACP knowledge and comprehension. Barriers to ACP and ACD implementation were more prominent in articles than facilitators. Conclusions Limited academic literature regarding the implementation and experience of ACP in prisons is available. The dominance of barriers identified in studies highlights key challenges for improving ACP uptake in correctional settings. Further research is required to understand the barriers, enablers, and attitudes to ACP in prisons.

scholarly journals Advance care planning and palliative care in ACHD: the healthcare providers’ perspective

2020 ◽  
Vol 30 (3) ◽  
pp. 402-408
Author(s):  
Jill M. Steiner ◽  
Erwin N. Oechslin ◽  
Gruschen Veldtman ◽  
Craig S. Broberg ◽  
Karen Stout ◽  
...  
Keyword(s):  
Palliative Care ◽  
Advance Directives ◽  
Advance Care Planning ◽  
Healthcare Providers ◽  
Cross Sectional Study ◽  
Physical Symptoms ◽  
Care Planning ◽  
Psychosocial Needs ◽  
Cross Sectional ◽  
Advance Care

ABSTRACTBackground:Advance care planning and palliative care are gaining recognition as critical care components for adults with CHD, yet these often do not occur. Study objectives were to evaluate ACHD providers’ 1) comfort managing patients’ physical symptoms and psychosocial needs and 2) perspectives on the decision/timing of advance care planning initiation and palliative care referral.Methods:Cross-sectional study of ACHD providers. Six hypothetical patients were described in case format, followed by questions regarding provider comfort managing symptoms, initiating advance care planning, and palliative care referral.Results:Fifty providers (72% physicians) completed surveys. Participants reported low levels of personal palliative care knowledge, without variation by gender, years in practice, or prior palliative care training. Providers appeared more comfortable managing physical symptoms and discussing prognosis than addressing psychosocial needs. Providers recognised advance directives as important, although the percentage who would initiate advance care planning ranged from 18 to 67% and referral to palliative care from 14 to 32%. Barriers and facilitators to discussing advance care planning with patients were identified. Over 20% indicated that advance care planning and end-of-life discussions are best initiated with the development of at least one life-threatening complication/hospitalisation.Conclusions:Providers noted high value in advance directives yet were themselves less likely to initiate advance care planning or refer to palliative care. This raises the critical questions of when, how, and by whom discussion of these important matters should be initiated and how best to support ACHD providers in these endeavours.

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