title: Health care professionals' perceptions and use of the medical orders for scope of treatment (MOST) form in North Carolina nursing homes.
abstract: OBJECTIVE
  To characterize the self-reported practices and opinions of nursing home (NH) health care professionals using the North Carolina Medical Orders for Scope of Treatment (MOST) form, an adaptation of the Physician Orders for Life-Sustaining Treatment (POLST) paradigm.
  
  
  METHODS
  A cross-sectional survey and semistructured interviews.
  
  
  METHODS
  Six physicians, 3 nurse practitioners, and 2 social workers from 2 NHs in North Carolina.
  
  
  METHODS
  Survey items covered timing and appropriateness of form completion, review criteria, barriers, and concerns about using the form. Interviews clarified survey responses and elicited descriptions of how subjects explain the scope of medical interventions to patients/families.
  
  
  RESULTS
  NH admission and routine care plan meetings were considered the most important times to complete the MOST form. Treatment options on the form were often introduced in the context of patient preferences for hospitalization; however, there were considerable differences in how health care professionals explained and interpreted the scope of medical interventions. Nearly all health care professionals (10/11) believed that the form improves communication between physicians and patients/families. Only 3 of 11 respondents were aware of all of the MOST form's review requirements. Time was the most commonly cited barrier to use of the form. Respondents were concerned about forms getting lost or not being honored outside of the NH.
  
  
  CONCLUSIONS
  Health care professionals generally viewed the MOST form as a useful tool for communicating patient treatment preferences in the NH. However, they may need specific strategies for explaining and interpreting the scope of medical interventions section and for meeting the form's review requirements.
authors: Division of Geriatric Medicine, University of North Carolina at Chapel Hill School of Medicine, Chapel Hill, NC 27599-7550, USA. acaprio@med.unc.ed
authors: Anthony J
authors: AJ
authors: Caprio
authors: Victoria P
authors: VP
authors: Rollins
authors: Ellen
authors: E
authors: Roberts
mesh_terms: D000328:Adult; D032722:Advance Care Planning / Q000592:standards / Q000706:statistics & numerical data*; D000368:Aged; D000369:Aged, 80 and over; D001291:Attitude of Health Personnel; D003142:Communication; D003430:Cross-Sectional Studies; D005260:Female; D006707:Homes for the Aged; D006801:Humans; D008297:Male; D008875:Middle Aged; D009657:North Carolina; D009723:Nurse-Patient Relations; D009735:Nursing Homes; D010348:Patient Care Team; D010349:Patient Compliance; D010817:Physician-Patient Relations; D011786:Quality Control; D018570:Risk Assessment; D011795:Surveys and Questionnaires