Dissertation/Thesis Abstract

Translating the Indiana Physician Orders for Scope of Treatment (POST) into practice
by Zeller, Sonya M., D.N.P., Indiana Wesleyan University, 2015, 133; 3743609
Abstract (Summary)

Advance care planning must be completed to ensure end-of-life healthcare preferences are discussed, documented, and honored. The Indiana Physician Orders for Scope of Treatment legislation became law, effective July 1, 2013, providing a form to document end-of-life healthcare preferences as a medical order. The Indiana POST form is the vehicle, but not the only focus. The focus is also on the conversations that should occur regarding an individual’s end-of-life healthcare preferences.

The Respecting Choices Advance Care Planning Model was the conversation model utilized to produce end-of-life healthcare preferences documented on the Indiana POST form. The risks lie in not performing advance care planning. Disregarding an individual’s healthcare preferences at end-of-life, is a medical error—“medical errors involve acts of omission as well as commission” (Allison & Sudore, 2013, p. 787). Allison and Sudore identified the breakdown in communication between the individual, family, and healthcare providers regarding end-of-life healthcare preferences resulting in physician orders not being concordant with patient end-of-life choices seventy percent of the time.

A qualitative translational continuous quality improvement study was conducted in an oncology clinic through a convenience sample of patients, age 18 years or older, who were newly diagnosed and died during the calendar year 2014 with Stage III or IV solid tumor or leukemia. Three aims were identified as building blocks: Aim 1—ongoing, staged conversations to produce Aim 2—end-of-life healthcare preferences documented on Indiana POST form to ensure Aim 3—choices are honored. The Respecting Choices Advance Care Planning guided the ongoing, staged communication model that directed the completion design for end-of-life healthcare preferences documented on the Indiana POST form. The translational continuous quality improvement plan analysis compared the Indiana POST documented end-of-life healthcare preferences to the actual care provided at end-of-life. The ongoing, staged communications between patients, families, and physicians minimized medical error risk through documentation of end-of-life healthcare preferences on the Indiana POST form to provide concordant individualized end-of-life quality care.

There were twenty-eight patients identified in 2014 from the oncology clinic who met the study criteria. Twenty-four of the twenty-eight had at least one advance directive completed and had met with a Respecting Choices First and Last Steps Facilitator. Four patients had not completed an advance directive or the Indiana POST. Of the four patients, three had met with the Respecting Choices First and Last Steps Facilitator and had begun the conversations to complete their advance directives and Indiana POST form. Eleven of the twenty-eight patients had an Indiana POST form completed, five died in 2014 and six remain alive. The five patients who completed the Indiana POST form and died in 2014 had a variety of healthcare preferences. All five patients had end-of-life healthcare preferences documented and available to the interprofessional healthcare team. All five of the patients had certified Respecting Choices First and Last Steps Facilitator assistance with the Indiana POST form documentation. All five of the patients had their Indiana POST form documentation of healthcare preferences honored at end-of-life.

Indexing (document details)
Advisor: Drake, Debbie
Commitee: Dismuke, Patsy
School: Indiana Wesleyan University
Department: Nursing
School Location: United States -- Indiana
Source: DAI-B 77/06(E), Dissertation Abstracts International
Subjects: Health care management
Keywords: End of life healthcare, Indiana Physician Orders for Scope of Treatment, Qualitative, Respecting choices advance care planning model, Terminal illness
Publication Number: 3743609
ISBN: 9781339363516
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