Survey of medical records demonstrates effectiveness of program to honor wishes of those with advanced illness or frailty
10/21/11 Portland, Ore.
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 percent 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 online in the Journal of the American Geriatrics Society.
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 percent of the time, and orders to limit medical interventions were honored 91.1 percent 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, Ph.D., 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 percent, 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 percent 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. 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.” said Naomi Karp, Senior Strategic Policy Advisor at the AARP Public Policy Institute.
POLST 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.
Oregon Health & Science University is the state’s only health and research university, and only academic health center. As Portland's largest employer and the fourth largest in Oregon (excluding government), OHSU's size contributes to its ability to provide many services and community support activities not found anywhere else in the state. OHSU serves patients from every corner of the state and is a conduit for learning for more than 4,310 students and trainees. OHSU is the source of more than 200 community outreach programs that bring health and education services to each county in the state.