Survey of medical records demonstrates effectiveness of POLST

Treatment preferences honored 94% of time

According to newly published research, a program created to communicate the treatment preferences of those with advanced illness or frailty ensures those preferences are honored 94% of the time. The Program, called Physicians Orders for Life Sustaining Treatment (POLST), was launched in Oregon almost 20 years ago.

POLST enables patients to document preferences to have or decline treatments in the form of medical orders. Since that time, the program has expanded to several other states across the nation. The latest research on the POLST program is printed on-line in the Journal of the American Geriatrics Society.1

The study was designed to assess whether the treatments provided were consistent with what was documented on the POLST form. A review of medical records and POLST forms for 870 living and deceased patients found that POLST orders about resuscitation were honored 98% of the time, and orders to limit medical interventions were honored 91.1% of the time.

"The research builds upon our previous findings that suggest the POLST program offers significant advantages over traditional methods like advance directives and Do Not Resuscitate orders to communicate patients' preferences about life-sustaining treatments," said lead author, Susan Hickman, PhD, an associate professor at the Indiana University and Oregon Health & Science University schools of nursing.

When patients identify treatments they do not want, the POLST form directs clinicians to use more extensive interventions to enhance comfort if needed. A majority, 74%, of the medical interventions provided to patients with POLST orders for "comfort care only" were focused on enhancing comfort, such as sending a patient to the hospital after a fall. Near the end of life, 24% of POLST orders were re-written to reflect a change of preferences, primarily for more comfort-focused care.

"This study renews AARP's conviction that POLST is a useful strategy for ensuring that people's treatment preferences are honored in their setting of care," said Naomi Karp, Senior Strategic Policy Advisor at the AARP Public Policy Institute. "Its striking results bolster the growing body of evidence that POLST does two important things for people with advanced illness or frailty: It helps elicit and document their treatment goals and choices, and it enhances the odds that they will get the care they want. AARP's own research on state POLST efforts provides a road map for the many states looking to start POLST programs, and this new clinical research provides evidence that those states are on the right track towards improving care for frail older citizens."

POLST also helps people avoid unwanted hospitalizations. "This study shows that the patient's comfort remains a high priority. Sometimes that means moving a patient who preferred to stay at the nursing home to the hospital for a short time to treat an accidental injury or uncontrolled symptoms," said Margaret Murphy Carley, Chair of the Oregon POLST Task Force and Executive Director of the National POLST Paradigm Task Force.

The next steps for the researchers are to study the process of completing a POLST form to learn how to best support patients and families in making difficult decisions about treatment in the face of serious illness.

Reference

1. Hickman SE, Nelson CA, Moss AH, et al. The consistency between treatments provided to nursing facility residents and orders on the Physician Orders for Life-Sustaining Treatment form. J Am Geriatr Soc 2011 Oct 22; Epub ahead of print.

Resource

For more information about the POLST Program, visit:

• POLST, Physicians Orders for Life-Sustaining Treatment Paradigm. Visit: www.ohsu.edu/polst/index.html. To review the POLST forms developed by various states, click on the "Programs" tab, then select "POLST Paradigm Forms."