From the Guidelines
For this 69-year-old male with multiple complex medical conditions, I would try to gather the patient's understanding of his illness and confirm code status. This approach is most appropriate because despite having a POLST form indicating Full Code, the patient has several serious conditions that could impact his prognosis and the effectiveness of resuscitation efforts 1. Before simply signing the existing POLST, it's essential to ensure the patient fully comprehends his current medical situation, especially given his recent intubation and new diagnoses.
Key Considerations
- The patient's understanding of his disease status, prognosis, and treatment history should be assessed 1.
- His goals of care and treatment preferences should be determined, considering how these relate to his life goals, activities of daily living, and quality of life 1.
- The involvement, agreement, and support of family members should also be evaluated 1.
Rationale
Given the patient's complex medical conditions, including COPD, respiratory failure, new right-sided heart failure, metastatic prostate cancer, and recent intubation, a focused discussion on his understanding of his illness and confirmation of his code status is crucial. This ensures that his preferences are informed by his current clinical reality, respecting his autonomy while providing appropriate medical guidance. While a complete Serious Illness Conversation Guide or immediate palliative care referral may not be necessary at this stage, gathering the patient's understanding and confirming his code status is a critical step in aligning his care with his wishes and values 1, 1.
From the Research
Assessment and Planning
- The patient is a 69-year-old male with multiple comorbidities, including COPD, respiratory failure, and metastatic prostate cancer, who has been admitted to the hospital for COPD exacerbation, PNA, acute bronchitis, and acute cystitis.
- He has a complex medical history, including tobacco use, OSA, possible new right-sided HF, chronic indwelling catheter, DM2, DVT, and partial seizure on levetiracetam.
- The patient required intubation during his recent hospitalization and has a POLST form requesting full code.
Considerations for Palliative Care
- Studies have shown that palliative care can improve quality of life and reduce symptom burden for patients with advanced illnesses, including cancer 2 and non-cancer illnesses 3.
- The patient's complex medical history and recent hospitalization suggest that he may benefit from a discussion about his goals of care and palliative care options.
- Referral to palliative care may be appropriate, as it has been shown to reduce acute health care use and improve symptom management 3.
Next Steps
- Try to gather the patient's understanding of his illness and confirm his code status, as this will inform the development of a care plan that aligns with his values and preferences.
- Consider referring the patient to palliative care for a goals of care conversation, as this can help to ensure that his care is aligned with his values and preferences 4, 5.
- Complete a full Serious Illness Conversation Guide to ensure that the patient's care plan is comprehensive and aligned with his values and preferences.