INDIANAPOLIS — The National Institute of Nursing Research has awarded $2.2 million to an IU School of Nursing professor at Indiana University-Purdue University Indianapolis to evaluate the use in Indiana nursing homes of a new advance-care planning tool created to help ensure that patients’ end-of-life treatment preferences are honored.
The research will provide information about how well the Physician Orders for Scope of Treatment tool reflects patients’ treatment preferences and how well patients understand the orders they are choosing. The advance-care planning tool is used by tens of thousands of patients across the United States.
The research team will be led by Susan Hickman, who teaches ethics in the nursing school and is co-director of the IUPUI Research in Palliative and End-of-Life Communication and Training Signature Center. The team will collect data and conduct interviews with nursing-home patients or their legal representatives.
Authorized by legislation adopted by the Indiana General Assembly in 2013, the Indiana POST is for patients near the end of life. Preferences for life-sustaining treatments, including resuscitation as well as medical interventions such as comfort care, hospitalization, intubation, mechanical ventilation, antibiotics and artificial nutrition, are documented as medical orders on the form.
It must be reviewed and signed by a physician to be activated. A patient or representative signature is also required. The POST form transfers throughout the health-care system, and the orders are valid in all settings
Hickman said POST was developed because one of the challenges in health care is that “we often fail to ask patients what they want.”
Nationally recognized for her work with POST, Hickman said, “My goal is to help support patients and families in thinking about what kinds of care they do and don’t want and to help them plan ahead.”
The research targets use of the form in nursing homes because many patients with advanced disease live and receive medical care in that setting, Hickman said. “This makes end-of-life planning particularly salient for these patients.”
“The goals of care are incredibly important to patients, especially as they near the end of life. These goals and what matters most to patients should shape the health care that they receive,” said study co-investigator Dr. Greg Sachs, a professor at the Indiana University School of Medicine and co-director of the IUPUI RESPECT Signature Center.
POST forms are used to document these goals as orders that “guide treatment decisions in an emergency,” Hickman said, “so it is critical that the information recorded in a patient’s medical record matches their current preferences.”
Findings will direct the development of interventions, guide practice improvements and inform policy to help ensure that care is consistent with the decision-maker’s preferences.
The research team also includes Alexia Torke, M.D., IU School of Medicine; Rebecca Sudore, M.D., University of California, San Francisco School of Medicine; and Bernard Hammes, Ph.D., Gundersen Health System.