The nurse practitioner's perspective of the physician orders for life-sustaining treatment (POLST) form

Abstract

The assessment, documentation, and implementation of a Physician Orders for Life-Sustaining Treatment (POLST) form are important for end-of-life care. As primary care providers, nurse practitioners have an important role in advanced-care planning, including the completion of POLST forms (Hayes et al., 2017). The purpose of this project was to better understand the self-reported practices and opinions of nurse practitioners as they assist patients in completing the form. The project was a partial needs assessment to inform later quality improvement (QI) work and used a survey design to assess and gain better understanding of the practices and opinions of nurse practitioners with the POLST form. Questions 1, 4, 6, and 8 were 'select all that apply' and Questions 2, 5, 7, and 9 required a single response. A total of 126 surveys were sent out with a response rate of 39.6%. Overall, nurse practitioners in Billings, Montana, were familiar with the POLST form (n=45, 90%). Half (n=28, 50%) of the nurse practitioners surveyed used the POLST form in their clinical practice despite having barriers to its completion such as it being time consuming (n=18, 25.7%). Over half (n=45, 60.0%) of the nurse practitioners surveyed believed that the most appropriate time to complete the POLST form was after a provider (any provider) discusses goals of care and medical treatments with the patient and/or family. Although some nurse practitioner respondents had no concerns with completing the POLST form (n=12, 21.1%), 21 of the respondents (n=21, 36.8%) reported issues regarding the understandability of the form for patients and/or families. Survey results showed familiarity of the POLST form is not a barrier to its completion in Billings, Montana, but 25.7% of the respondents believed the time it takes to complete the form was a barrier to completing it with patients and/or families. Nurse practitioners could include extra time in appointments or use annual wellness visits to discuss goals of care with patients and/or families. Future effort could also focus on reducing the amount of time nurse practitioners spend filling out a POLST form accurately and completely with their patients and/or families.