Assessment of the construct validity of the POLST form (Physician Orders for Life-Sustaining Treatment)

Abstract

In Brazil most health care professionals and institutions still have not included discussions about preferences of care at the end of life with patients with decreased life expectancy as part of their daily routine. This represents a major gap for the care at the close of life in Brazil that is frequently associated with avoidable suffering of patients and their loved ones. In 1991 the Physician Orders for Life-Sustaining Treatment (POLST) program was started in the USA. It embodies a coordinated system to elicit, record and communicate patients' and families' preferences about life-prolonging treatments for individuals with decreased life expectancy across a variety of health care settings. The POLST paradigm has spread across the USA and currently represents one of the most successful strategies to elicit and record preferences of care at the end of life in that country. Recently we have concluded the cross-cultural adaptation of the POLST form to Brazil. According to our literature review and after consultation with the National POLST Paradigm Task Force in the USA, to this moment no studies have been conducted examining the construct validity of the POLST form. Hence, aiming to provide data to support the future use of the POLST form in Brazil, we propose the present study to examine the construct validity of the POLST form adapted to Brazil. Methods: The assessment of the construct validity of the POLST form will follow the recommendations of the Consensus based Standards for the selection of health Measurement Instruments (COSMIN) by means of the hypothesis testing approach. The hypothesis to be tested is that the agreement between the POLST form and a discussion about objectives of care / advance care planning will correspond to a value of weighted Kappa equal or above 0.75. Two independent researchers will perform those interviews during the hospitalization period and within 7 days of each other. Sixty-two patients will be invited to participate in the study. Inclusion criteria are age equal or above 21 years, be an inpatient at our University Hospital, and have at least one of the physicians involved in their care provide a negative answer to the question "Would you be surprised if that patient died within one year?". (AU)