The Physicians Order for Life Sustaining Treatment (POLST) is a planning tool representative of an emerging paradigm aimed to facilitate elicitation of patient end-of-life care preferences and to ensure that such preferences are honored wherever the patient receives care. This patient-centered communication approach to advance care planning requires patients and health care providers to engage in difficult conversations regarding treatment options and preferences. The proposed study assesses the impact of the POLST document on health care provider goals and plans for conversations about end-of-life care treatment options. A 2 (POLST: experimental, control) x 3 (topic of possible patient misunderstanding: CPR, medical intervention, artificially administered nutrition) experimental design was employed to assess goals, plans, and strategies for plan creation and alterations by medical professionals. Findings suggest that the POLST had little impact on plan complexity or reaction time with initial plans. However, preliminary evidence suggests that the utility of the POLST comes when providers need to provide responses to patient misunderstanding. Significant differences in goals were identified, with arousal management emerging as the primary goal in shaping conversational engagement. The role of goals, provider experience, concern for consequences and meta-goals or constraints are discussed. As goals and plans drive behavior, the results of this study are a means to identify existing constraints to health care provider conversational engagement and the utility of POLST in planning the process.
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