Improving advanced practice clinicians' knowledge and comfort of physician orders for life-sustaining treatment form: A homecare quality improvement initiative.

PURPOSE/AIMS: Many advanced practice clinicians (APCs) lack formal training on how to effectively discuss the Physician Orders for Life-Sustaining Treatment (POLST) with chronically ill older adults, often leading to communication gaps and delayed end-of-life decisions. This quality improvement initiative aimed to improve APCs knowledge and comfort in initiating and documenting POLST discussions with community-dwelling geriatric patients.

METHODS: A one-hour online training, incorporating didactic instruction, role-playing, and debriefing, was delivered for APCs providing home-based care. Surveys conducted before and after the training measured changes in knowledge and comfort levels, while retrospective chart reviews examined POLST documentation and referrals to palliative care and hospice services.

RESULTS: Forty-five APCs consented to participate; 37 completed all three surveys. EMR data were analyzed for 43 APCs, and referral data for all 45. At three months, modest improvements were observed in POLST knowledge, comfort, and referrals to palliative care and referrals to hospice. Statistically significant improvements were observed in POLST completion documentation (p < 0.001), POLST discussions documentation (p < 0.001), POLST upload documentation (p < 0.001), hospice knowledge (p = 0.023), palliative care knowledge (p = 0.002), preparedness to discuss POLST (p = 0.02), comfort with end of life conflict discussions (p = 0.04), addressing religious/cultural perspectives (p < 0.001), and use of structured communication frameworks (p < 0.001).

CONCLUSION/IMPLICATIONS: The targeted online experiential POLST education intervention demonstrated a scalable approach to advance care planning, with observed gains in APCs knowledge, comfort, and documentation in home-based geriatric care.