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Surrogates' experiences of engaging in Physician Orders for Life-Sustaining Treatment discussions for persons with advanced dementia

Kim, Hyejin PhD, RN (Post-doctoral Fellow)1; Bradway, Christine PhD, RN (Associate Professor of Gerontological Nursing)2; Hickman, Susan E. PhD (Professor)3; Ersek, Mary PhD, RN (Senior Scientist and Professor of Palliative Care)2,4

Journal of the American Association of Nurse Practitioners: February 2018 - Volume 30 - Issue 2 - p 69–77
doi: 10.1097/JXX.0000000000000024
Research - Qualitative

Background and purpose: Little is known about surrogates' experiences of engaging in Physician Orders for Life-Sustaining Treatment (POLST) discussions. This study describes family surrogates' experiences when engaging in POLST discussions with primary care providers.

Methods: Semistructured interviews were conducted with 10 family surrogates of individuals with advanced dementia who were enrolled in a Program of All-Inclusive Care for the Elderly or resided in a nursing home. Interviews were analyzed using directed content analysis based on the conceptual model of communication and surrogate decision making by Torke et al.

Results and conclusion: Surrogates reported that clear explanations of clinical information and the opportunity to ask questions and reiterate what they heard were helpful in making treatment decisions. Moreover, surrogates reported feeling respected and understood when providers expressed concern for them or their family member with advanced dementia and asked them about their emotional responses to decision making. Although nine surrogates reported very positive communication with providers, one surrogate expressed discomfort with the interaction and described feeling pressured to make health care decisions.

Implications for practice: With effective communication, family surrogates feel emotionally supported during communication and decision-making processes. Providers are encouraged to focus on developing expert communication skills for end-of-life care discussions.

1Center for Nursing Excellence in Palliative Care, Emory University School of Nursing, Atlanta, Georgia,

2Biobehavioral Health Sciences, University of Pennsylvania School of Nursing, Philadelphia, Pennsylvania,

3Indiana University School of Nursing, Indianapolis, Indiana,

4Veteran Experience Center, Corporal Michael J. Crescenz VAMC, Philadelphia, Pennsylvania

Correspondence: Hyejin Kim, Emory University School of Nursing, 1520 Clifton Road, Atlanta, GA 30322. Tel: (404) 727-5937; E-mail:

Competing interests: The authors report no conflicts of interest.

Authors' contributions: All authors engaged in developing the research project, analyzing the data, and revising the manuscript for final submission. Hyejin Kim performed recruitment, data collection, and initial analysis and wrote the initial draft of the manuscript.

Received October 31, 2017

Received in revised form November 24, 2017

Accepted January 03, 2018

© 2018 American Association of Nurse Practitioners
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