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POLST helps avoid unwanted hospital stay
A study evaluating the use of Physician Orders for Life-Sustaining Treatment (POLST) in nursing homes found that patients with a POLST are less likely to receive unwanted hospitalization and medical interventions than patients without a POLST.1
Because POLST enables a person to be more specific about the type of care desired, researchers found that patients with POLST forms saying they wished to receive care primarily focused on relieving their pain and suffering were 59% less likely to receive unwanted treatments such as hospitalization than those who had only a do-not resuscitate (DNR) order.
The study evaluated the records of 1,711 nursing facility residents aged 65 and older with a minimum stay of 60 days in 90 Medicaid-eligible nursing facilities in Oregon, Wisconsin, and West Virginia.
The authors point out that traditional practices for documenting and communicating end-of-life treatment preferences beyond CPR generally have not been found to be helpful in making treatment decisions at the bedside and do not alter care, but the findings from this study suggest that the POLST program might make a difference. However, nursing facility residents with POLST forms have more medical orders reflecting treatment preferences about CPR and other interventions than residents without POLST forms, which suggests more consistency in the generation of such orders than is seen with traditional practices, the authors say.
POLST form use alone did not affect symptom frequency or management, which suggests comparable attention to comfort in both groups. Residents with POLST forms reflecting preferences for comfort measures only were significantly less likely to receive life-sustaining medical interventions (13.7%) than residents with POLST full treatment orders (22.9%), traditional DNR orders (25.9%), or traditional full code orders (24.4%). (For more information on POLST, see "Oregon POLST registry secures 18,000 forms Data is at 5 months post-launch, Hospice Management Advisor, July 2010, p. 80.)
1. Hickman SE, Nelson CA, Perrin NA, et al. A comparison of methods to communicate treatment preferences in nursing facilities: Traditional practices versus the physician orders for life-sustaining treatment program. J Am Geriatr Soc 2010; 58:1,241-1,248.