Patient–physician conversations about life-sustaining treatment: Treatment preferences and participant assessments. Issue 1 (February 2023)

• Record Type: Journal Article
• Authors: Tuesen, Lone Doris; Bülow, Hans-Henrik; Ågård, Anne Sophie; Strøm, Sverre Maintz; Fromme, Erik; Jensen, Hanne Irene
• Is Part Of: Palliative & supportive care. Volume 21:Issue 1(2023)
• Page Start: 20
• Page End: 26
• Publication Date: 2023-02
• Subjects: Advance care planning -- End of life -- Ethics -- Life-sustaining treatment -- Shared decision-making; Palliative treatment -- Great Britain -- Periodicals; 616.029
• DOI: 10.1017/S1478951521001875
• Languages: English
• ISSNs: 1478-9515

Abstract

Abstract: Objective: In 2019, the Danish parliament issued legislation requiring Danish physicians to clarify and honor seriously ill patients' treatment preferences. The American POLST (Physician Orders for Life-Sustaining Treatment) document could be a valuable model for this process. The aim of the study was to examine patients' preferences for life-sustaining treatment and participant assessment of a Danish POLST form. Methods: The study is a prospective intervention based on a pilot-tested Danish POLST form. Participant assessments were examined using questionnaire surveys. Patients with serious illness and/or frailty from seven hospital wards, two general practitioners, and four nursing homes were included. The patients and their physicians completed the POLST form based on a process of shared decision-making. Results: A total of 95 patients (aged 41–95) participated. Hereof, 88% declined cardiopulmonary resuscitation, 83% preferred limited medical interventions or comfort care, and 74% did not require artificial nutrition. The preferences were similar within age groups, genders, and locations, but with a tendency toward younger patients being more in favor of full treatment and nursing home residents being more in favor of cardiopulmonary resuscitation. Questionnaire response rates were 69% (66/95) for patients, 79% (22/28) for physicians, and 31% (9/29) for nurses. Hereof, the majority of patients, physicians, and nurses found that the POLST form was usable for conversations and decision-making about life-sustaining treatment to either a high or very high degree. Significance of results: The majority of seriously ill patients did not want a resuscitation attempt and opted for selected treatments. The majority of participants found that the Danish POLST was usable for conversations and decisions about life-sustaining treatment to either a high or a very high degree, and that the POLST form facilitated an opportunity to openly discuss life-sustaining treatment.