Adherence to Patients’ Preferences for Levels of Life-Sustaining Treatment: A 2-Year Follow-Up Study

Abstract

Objective

There is increasing interest in advance care planning (ACP) and the implementation of various forms of ACP. The purpose of ACP is to define patients’ goals and preferences for future medical treatment and care for patients nearing the end of life (EOL). The aim of this study was to investigate adherence to patients’ preferences for levels of life-sustaining treatment in emergency situations, as documented in a Danish POLST (Physician Orders for Life-Sustaining Treatment) form.

Methods

A retrospective journal review was conducted 2 years after the conversation with the patients about their wishes for treatment and care at EOL. Medical records included electronic hospital records, nursing home records, and general practice records. Patients were assessed nearing EOL and included in the study based on a negative response to the “surprise.”

Results

A total of 120 patients and nursing home residents were included in the study. Overall, there were 2148 contacts with the healthcare system, of which 31 were emergency situations, where the patients were not capable of expressing their own wishes. In 4 contacts (12%), the patients (4) received treatment discordant with their wishes, as documented in the POLST form (and medical record).

Conclusions

Our study shows that patients assessed nearing EOL are a patient group with many contacts with the healthcare system, and the results indicate that having had an ACP conversation and the wishes documented is useful to avoid unwanted treatment in emergency situations.

Keywords

advance care planning POLST form end-of-life conversation the surprise question emergency situations treatment at end of life

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