Abstract
Abstract
Background
Advance care planning (ACP) involves discussions about patient and families’ wishes and preferences for future healthcare respecting autonomy, improving quality of care, and reducing overtreatment. The Medical Orders for Scope of Treatment (MOST) form records person preferred level and types of treatment and intervention.
Purpose
To examine the MOST form use in inpatient units within a British Columbia (Canada) hospital, estimate and compare its completion rate, and inform health policies for continuous, quality and individualized patient care.
Methods
About 5,000 patients admitted to the participating tertiary acute care hospital during October 2020. Data from 780 eligible participants in medical, surgical, or psychiatry unit were analyzed with descriptive statistics, the chi-square test for group comparisons, and logistic regression to assess predictors of the MOST form completion.
Results
Participants’ (54% men) age ranged from 20–97 years (mean = 59.53, SD = 19.54). Mainly physicians (99.1%) completed the MOST form for about 60% of them. A statistically significant difference of MOST completion found among the units [Pearson χ2(df=2, n=780) = 79.53, p < .001, φ = .319]. Multivariate logistic regression analysis demonstrated that age (OR = 1.05, 95% CI 1.04 to 1.06) and unit admission (OR = .60, 95% CI 0.36 to 0.99 in psychiatry; and OR = .21, 95% CI 0.14 to 0.31 in surgery) were independently associated with the MOST form completion.
Conclusion
Our findings demonstrate a need for consistent and broad completion of the MOST form across all jurisdictions using, desirably, advanced electronic systems. Healthcare providers need to raise awareness of the MOST completion benefits and be prepared to discuss topics relevant to end-of-life. Further research is required on the MOST form completion.
Publisher
Springer Science and Business Media LLC
Reference43 articles.
1. D'Arrigo T. A 2-pronged approach to advance care planning. ACP Internist. 2015. https://acpinternist.org/archives/2015/09/advanced-directive.htm.
2. Silveira MJ. Advance care planning and advance directives Retrieved from Up-to-date (peer reviewed). 2020. Available from: https://www.uptodate.com/contents/advance-care-planning-and-advance-directives.
3. Fleuren N, Depla MFIA, Janssen DJA, Huisman M, Hertogh CMPM. Underlying goals of advance care planning (ACP): A qualitative analysis of the literature. BMC Palliat Care. 2020;19(27):1–15.
4. Jimenez G, Tan WS, Virk AK, Low CK, Car J, Ho AHY. State the advance care planning research: A descriptive overview of systematic reviews. Palliat Support Care. 2019;17(2):234–44.
5. Health Canada. Action plan on palliative care: Building on the framework on palliative care in Canada. 2018.
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