Conversational planning about end-of-life care: health care provider reported resources, prioritization, and knowledge

Abstract

ABSTRACTBackground: Developing conversational plans can potentially help ameliorate some of the apprehension that medical providers feel when approaching end-of-life conversations. The Physician Orders for Life-Sustaining Treatment (POLST) is a planning tool representative of an emerging paradigm aimed at facilitating elicitation of patient end-of-life care preferences. With specific interest in the POLST, this study assessed the sources that providers draw upon in their plan construction, perceptions of domain knowledge, prioritization and the relative impact such factors had on plan complexity.Method: Respondents (n = 297) were asked to design a plan to communicate to the patient about their options for life-sustaining treatment. Following the plan generation, questions concerning prioritization, domain specific knowledge, as well as the resources that are drawn upon to engage in such conversations were elicited.Results: Health care providers most commonly reported reliance on personal experience in plan development with limited utilization of the POLST. Increased prioritization and domain knowledge were associated with greater plan complexity.Conclusions: The findings suggest that with greater experience, providers are better able to articulate in detail what needs to be considered in conversational engagement with patients regarding end-of-life treatment options.