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 patients’ end-of-life treatment preferences are honored.
The research will show how well existing Physician Orders for Scope of Treatment (POST) orders reflect patients’ treatment preferences and how well patients understand the orders. 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 and their legal representatives.
Authorized by legislation adopted by the Indiana General Assembly in 2013, the POST is for patients with advanced illness. Preferences for life sustaining treatments, including resuscitation, 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. 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 healthcare is that “we in healthcare often fail to ask people what they want.”
Nationally recognized for her work with POST, Hickman said, “my work is really designed to help support patients and families in thinking ahead about what kinds of care they do and don’t want and help them be able to plan ahead.”
The research targets use of the form in nursing homes because for many seriously ill patients that is where they live and receive medical care, Hickman said. “That fact that the nursing home is both a residence and a medial facility makes these end-of-life planning issues particularly salient.”
These issues about goals of the care become incredibility important, because it can shape their daily experience throughout the last weeks and months of their life, including where a patient spend their final days on this earth,” said study co-investigator Dr. Greg Sachs, professor, Indiana University School of Medicine, and Co-Director of the IUPUI RESPECT Signature Center.
“These orders guide treatment decisions in an emergency, so it is critical that the information recorded in a patient’s medical record matches their current preferences.” he said.
“I think one of the most important benefits that we can provide is to give patients the opportunity to talk with their families about what gives their life meaning and then provide that experience in the last months of their life in a manner that matches what is important to them,” Hickman said.
Findings will direct the development of interventions, guide practice improvements, and inform policy to help ensure that care that is consistent with the decision-maker’s preferences.
The research team also includes Alexia Torke, MD, MPH, IU School of Medicine, Rebecca Sudore, MD, University of California San Francisco, and Bernard Hammes, PhD, Gundersen Health System.