of a Facilitated Advance Care Planning Process in an Assisted Living Facility
A. Hall, MS, RN
Jenson, DNP, RN, ACNS-BC, CCRN
percent of people are incapable of making decisions about treatment when they
reach the end of life, leaving others to decide. When uncertainty exists,
healthcare professionals default to aggressive treatment, often resulting in
less quality of life for patients and the experience of regret and depression
for caregivers following the death. The Patient Self Determination Act and
advance directives have not successfully provided for consistently available
information about well-informed preferences for care at the end of life.
centered advance care planning and Provider Orders for Life Sustaining
Treatment have evolved as methods to provide for thoughtfully considered and
well-informed preferences available to guide care decisions at the end of
purpose of this project was to implement the Respecting Choices® model of
Provider Orders for Life-Sustaining Treatment (POLST)-type advance care
planning in an assisted living facility. POLST-type advance care planning
results in a document that communicates care preferences as a provider’s
order, actionable in local healthcare settings.
evidence based project, completed in the context of a community-wide
implementation effort, focused on implementation of an evidence-based
intervention (POLST-type advance care planning) among residents of an
assisted living facility.
residents and their healthcare agents participated in POLST-type advance care
planning; POLST documents were signed by the physician. Follow-up chart
review indicated that residents who experienced POLST-type advance care
planning had more provider orders addressing life-sustaining treatments than
were previously present. Ninety-four percent of participants who completed a
satisfaction survey rated the overall quality of the discussion as excellent.
end-of-life medical care will be consistent with stated, well-considered
preferences. Health care agents will be involved in ensuring residents’
preferences are honored. Health care providers will have clear, reliable
documentation to inform care at the end of life.