The Problems With Physician Orders for Life-Sustaining Treatment

Achieving Goal-Concordant Care: A Conceptual Model and Approach to Measuring Serious Illness Communication and Its Impact

“…71,72 Third, ADs inconsistently demonstrate their impact on the delivery of goalconcordant care, with a majority of studies showing little association between the two. 73 Finally, limited portability and inconsistent interpretation by family and clinicians limit implementation of ADs. 70,73 Legal documents, such as living wills, are not universally accessible.…”

“…73 Finally, limited portability and inconsistent interpretation by family and clinicians limit implementation of ADs. 70,73 Legal documents, such as living wills, are not universally accessible. Portable medical orders, such as Physician's Orders for Life-Sustaining Treatment (POLST) or Medical Orders for Life-Sustaining Treatment (MOLST), have been shown to influence location of death in accordance with stated preferences, 74 but patient selection remains unclear and some have raised concerns about their interpretability and degree of patient centeredness.…”

Data Needs for a Serious Illness Care Accountability System: A Framework and Recommendations

“…As of 2017, 48 states have POLST programs, although actual submission of documents to them remains low, and the adequacy of communication during care planning has been questioned. 6,7 There is an opportunity to build engagement with these programs and help them expand and improve. While these initiatives may increase development of advance directives, the documents are often not made accessible via EHRs.…”

Quality of Physician Orders for Life-Sustaining Treatment Forms Completed in Nursing Homes

“…6 As adoption of POLST forms spreads, concerns about the quality of completed forms have emerged. 3,7,8 Recent reviews identify challenges ranging from lack of education about the form for providers (Hickman, 2015) to insufficient high-quality evidence that POLST forms and other advance care documents actually engage healthcare professionals in end-of-life discussions. 7 In addition, there is a dearth of evidence documenting the quality of completed POLST forms, particularly those completed in nursing homes (NHs).…”