{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,1,25]],"date-time":"2026-01-25T04:10:57Z","timestamp":1769314257141,"version":"3.49.0"},"reference-count":28,"publisher":"Wiley","issue":"1","license":[{"start":{"date-parts":[[2020,12,10]],"date-time":"2020-12-10T00:00:00Z","timestamp":1607558400000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/onlinelibrary.wiley.com\/termsAndConditions#vor"}],"content-domain":{"domain":["onlinelibrary.wiley.com"],"crossmark-restriction":true},"short-container-title":["J of Healthc Risk Manag"],"published-print":{"date-parts":[[2021,7]]},"abstract":"<jats:title>ABSTRACT<\/jats:title><jats:sec><jats:title>Objective<\/jats:title><jats:p>Utilize simulation to evaluate if living wills (LW) or POLST achieves goal concordant Care (GCC) in a medical crisis.<\/jats:p><\/jats:sec><jats:sec><jats:title>Methods<\/jats:title><jats:p>Nurses and resident\u2010physicians from a single center were randomized to a clinical scenario with a living will (LW), physician orders for life sustaining treatment (POLST) or no document. Primary outcomes were resuscitation decision and time to decision. Secondary outcome was the effect of education.<\/jats:p><\/jats:sec><jats:sec><jats:title>Results<\/jats:title><jats:p>Total enrollment was 57 and less than 30% received prior training. Types of directives were linked to resuscitation decisions (<jats:italic>P<\/jats:italic> = .019). Participants randomized to \u201cNo Document\u201d or POLST specifying \u201cCPR\u201d performed resuscitation. If a terminal condition presented with a POLST\/ do not resuscitate\u2010comfort measures only (DNR\u2010CMO), 73% resuscitated. The LW or POLST specifying DNR combined with medical support resulted in resuscitations in 29% or more of the scenarios. Documents did not significantly affect median time\u2010to\u2010decision (<jats:italic>P<\/jats:italic> = .402) but decisions for \u201cNo Document\u201d and POLST\/CPR were at least 10 s less than other scenarios. Scenarios involving POLST DNR\/Limited Treatment had the highest median time of 43 s. Prior training in LWs and POLST exerted a 10% improvement in decision making (<jats:italic>P<\/jats:italic> = .537).<\/jats:p><\/jats:sec><jats:sec><jats:title>Conclusion<\/jats:title><jats:p>GCC was not always achieved with a LW or POLST. This conclusion supports prior research identifying problems with the interpretation and discordance with LW's and POLST.<\/jats:p><\/jats:sec>","DOI":"10.1002\/jhrm.21453","type":"journal-article","created":{"date-parts":[[2020,12,11]],"date-time":"2020-12-11T04:35:50Z","timestamp":1607661350000},"page":"22-30","update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":3,"title":["TRIAD XI: Utilizing simulation to evaluate the living will and POLST ability to achieve goal concordant care when critically ill or at end\u2010of\u2010life<b>\u2014<\/b>The Realistic Interpretation of Advance Directives"],"prefix":"10.1002","volume":"41","author":[{"given":"Ferdinando","family":"Mirarchi","sequence":"first","affiliation":[{"name":"Department of Emergency Medicine UPMC Hamot  Erie Pennsylvania"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Kristin","family":"Juhasz","sequence":"additional","affiliation":[{"name":"Department of Emergency Medicine UPMC Hamot  Erie Pennsylvania"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Timothy","family":"Cooney","sequence":"additional","affiliation":[{"name":"Department of Emergency Medicine UPMC Hamot  Erie Pennsylvania"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Daniel","family":"Desiderio","sequence":"additional","affiliation":[{"name":"Department of Emergency Medicine UPMC Hamot  Erie Pennsylvania"}],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"311","published-online":{"date-parts":[[2020,12,10]]},"reference":[{"key":"e_1_2_6_2_1","doi-asserted-by":"publisher","DOI":"10.1007\/s11606-012-2178-2"},{"key":"e_1_2_6_3_1","doi-asserted-by":"publisher","DOI":"10.1089\/109662102753641322"},{"key":"e_1_2_6_4_1","unstructured":"California Advocates for Nursing Home Reform (CANHR). 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