Table 3.
Resident and Surrogate Reasons for POLST Preference Discordance and Concordance.
| Reasons for Discordance | |
| Problematic Nursing Facility Practices | “When I was doing them (the POLST decisions), I was doing a stack of papers. I was signing my name and signing my name and signing my name. So after a while you get a little blurred.” (resident) |
| “I was having to answer tons of questions. It wasn’t just the POLST form. That was just another sheet of paper that I had to fill out. There was all kinds of paperwork that you have to do when you’re putting somebody in a long term facility. So I barely even remember even filling it out. I can’t necessarily say I wasn’t comfortable with it or I was because I don’t really remember. There was so much stuff that I wasn’t comfortable with at that time.” (surrogate) | |
| “...And see, like I said before when I was filling it out, there wasn’t anybody to explain anything....” (resident) | |
| “Well I kind of had a little bit of trouble getting (staff member) to understand some of the decisions I made...” (resident) | |
| Missing Information | “And that goes back to the pneumonia that you mentioned. That’s something I had never considered, something that she could recover from. I mean even at this point in her life I think she could possibly come back from that. I just had never considered it... when I did this paperwork I was thinking more and even all the way up to today I was thinking more of lung cancer, COPD, heart failure or something like that.” (surrogate) |
| “Like I said, I knew with CPR about the ribs as a potential danger, but I don’t know that I knew all the details about the breathing tube.” (surrogate) | |
| Deferring to Others | “I might have answered the question that way [on POLST] for my younger sister’s benefit because she is so, oh my gosh, it’s hard for her to accept anything. Mom and dad is going to live forever. We all know that’s not true.” (surrogate) |
| “I think I had stronger input from family members and I kind of just acquiesced because it made sense at the time.” (surrogate) | |
| “My daughter does everything for me.” (resident) | |
| Re-evaluating what is best | “I feel like now he has declined so much from [when the POLST was completed]. He’s been on hospice. I just feel like making the rest of his life just comfort, not thinking about prolonging it, just thinking more about his comfort and making the best of the time that we have left, rather than putting him through things that probably aren’t going to make a difference anyway.” (surrogate) |
| “...actually I think she’s doing better since she is there. They make her get up and they can get her to the bathroom and they can get her to do the things that she needs to do... I think her health is a little bit better. So that’s probably a little bit of [the reason for the change in preference].” (surrogate) | |
| Inability to remember or explain | “I don’t know why. Especially since that was after I had gone to the hospital because I really don’t know why (resident).” |
| “That’s a hard decision to make. I can’t explain why... It just seems to me that that would be a better choice at this point (resident).” | |
| Reasons for Concordance | |
| No Change/Unlikely to Improve | “Because nothing has changed, and nothing is going to change. [The resident] is not going to get better.” (surrogate) |
| “Well it might be that I feel pretty close to the same.” (resident) | |
| “Because of what I’ve been told by the doctors and what I’m seeing when I see her how she’s going downhill and I just want her, if anything happens, I just want her to be comfortable. I don’t want any tubes and things connected to her.” (surrogate) | |
| Substituted Judgment | “I know that’s what dad wanted and he and my mom had both, they had everything all planned out so it wasn’t hard to go ahead and do that because I knew what he wanted.” (surrogate) |
| Stable Preferences/No Insight | “I made the choices three years ago and I guess I really meant them.” (resident) |
| “It’s just what I think.” (resident) | |