Physician Orders for Life‐Sustaining Treatment (POLST): Outcomes in a PACE Program

Lee, Melinda A.; Brummel‐Smith, Kenneth; Meyer, Jan; Drew, Nicholas; London, Marla R.

doi:10.1111/j.1532-5415.2000.tb02594.x

Cited by 98 publications

(95 citation statements)

References 21 publications

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“…This finding stands in contrast to a number of studies concluding that preferences fail to determine the receipt of specific medical interventions. 12,16,17 This difference in conclusions results in part from the conceptualization of end-oflife care in terms of pathways of care. These pathways were developed with the recognition that specific interventions can be used with different goals regarding the outcomes of care and attempt to capture how well patients' care goals are met at the end of life.…”

Section: Discussionmentioning

confidence: 94%

“…8 Studies prospectively evaluating patients' preferences and their relationship to the care patients receive have focused on the site of death [9][10][11] or on the receipt of specific interventions. [12][13][14][15][16][17] Determining whether patients' preferences for end-of-life care have been met requires an examination of whether the care that they receive is consistent with their goals or, in other words, whether the treatment will provide the outcomes that patients desire. This is because patients' preferences are shaped by the probable outcomes of treatment rather than the specific intervention itself.…”

Section: Introductionmentioning

confidence: 99%

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The Association between Treatment Preferences and Trajectories of Care at the End-of-Life

et al. 2007

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Section: Discussionmentioning

confidence: 94%

Section: Introductionmentioning

confidence: 99%

The Association between Treatment Preferences and Trajectories of Care at the End-of-Life

et al. 2007

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“…In a smaller, retrospective study of 54 frail elderly adults enrolled in a capitated senior health program, only 39% (21 of 54) had their POLST orders followed consistently. 3 A study of hospice patients found a high rate of consistency between treatments provided and POLST orders. 4 A recent retrospective study 5 compared the use of POLST with the standard approach of writing medical orders for 1711 long-term care residents in three states.…”

mentioning

confidence: 99%

The POLST Program: A Retrospective Review of the Demographics of Use and Outcomes in One Community Where Advance Directives Are Prevalent

Hammes

Rooney

Gundrum

et al. 2012

Journal of Palliative Medicine

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Objectives: Determine the use and utility of the Physician Orders for Life-Sustaining Treatment (POLST) program in a community where powers of attorney for health care (POAHCs) are prevalent. Methods: A retrospective review of medical record and death certificate data of 400 adults who died between September 1, 2007, and March 31, 2008, in the La Crosse County, Wisconsin community. Demographic and cause-of-death data were collected from death certificates. Information about POAHC, POLST forms, and medical treatments provided in the last 30 days of life were abstracted from decedents' medical records. Results: Sixty-seven percent of decedents had a POLST form, whereas 22% had POAHC alone. In comparison with decedents with POAHC alone, decedents with a POLST form were significantly older (83 versus 77 years, p < 0.001), more likely to die in a nursing home than in a hospital ( p < 0.001), and more likely to die from a terminal or chronic illnesses (97%). Decedents with POLST orders for higher levels of medical treatment received more treatment, and in only two cases was there evidence that treatment was discrepant with POLST orders. In 31% of all POLST forms, the person appointed in the POAHC consented to the POLST orders. Conclusions: POLST can be a highly effective program to ensure that patient preferences are known and honored in all settings. POAHCs are valuable because they identify appropriate surrogates when patients are incapacitated.

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“…37 Tracking this innovation as a natural experiment, investigators have found evidence that POLST is effective to facilitate care consistent with preferences for older patients in nursing homes, PACE, and hospice. [38][39][40] Can Interventions Improve the Quality of Decision Making?…”

Section: -31mentioning

confidence: 99%

Research Priorities for Geriatric Palliative Care: Goals, Values, and Preferences

Hanson¹,

Winzelberg²

2013

Journal of Palliative Medicine

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Older patients and their families desire control over health decisions in serious illness. Experts recommend discussion of prognosis and goals of care prior to decisions about treatment. Having achieved longevity, older persons often prioritize other goals such as function, comfort, or family support-and skilled communication is critical to shift treatment to match these goals. Shared decision making is the ideal approach in serious illness. Older patients desire greater family involvement; higher rates of cognitive impairment mean greater dependency on surrogates to make decisions. Despite the importance of communication, fewer than half of older patients or families recall treatment discussions with clinicians, and poor quality communication adversely affects family satisfaction and patient outcomes. Direct audiorecording of clinical encounters and longitudinal studies of communication and treatment decisions have yielded important insights into the quality of clinical communication. Current clinical practice rarely meets standards for shared decision making. Innovative methods to record and use patient preferences show promise to overcome the limitations of traditional advance directives. Decision aids, intensive clinician training, and structured interpersonal communication interventions have all been shown to be effective to improve the quality of communication and decision making. Priorities for geriatric palliative care research, building on these insights, now include empirical testing of communication approaches for surrogates and for diverse populations, exploration of meaningful ways to communicate prognosis, and expansion of intervention research.What Defines Quality in Health Care Communication?

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Physician Orders for Life‐Sustaining Treatment (POLST): Outcomes in a PACE Program

Cited by 98 publications

References 21 publications

The Association between Treatment Preferences and Trajectories of Care at the End-of-Life

The Association between Treatment Preferences and Trajectories of Care at the End-of-Life

The POLST Program: A Retrospective Review of the Demographics of Use and Outcomes in One Community Where Advance Directives Are Prevalent

Research Priorities for Geriatric Palliative Care: Goals, Values, and Preferences

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