The Journal of the American Geriatrics Society (JAGS) has published a landmark study on the relationship between what POLST orders are selected and where people ultimately die. The study, titled Association between Physician Orders for Life-Sustaining Treatment for Scope of Treatment and In-Hospital Death in Oregon, demonstrates that POLST orders for those with serious illness or frailty are honored.
The study is the largest research project to date on the outcomes of the POLST Paradigm, and shows that patients with POLST Forms indicating Comfort Measures Only or Limited Additional Interventions are significantly less likely to die in a hospital than individuals without a POLST Form. As importantly, the research also reveals that patients with POLST Forms indicating Full Treatment are significantly more likely to die in a hospital than individuals without a POLST Form.
The research is based on the Oregon POLST Program, which has Mature Status from the National POLST Paradigm Task Force (NPPTF). While the results can not be generalized to all POLST Programs at various stages of development, the study conclusively shows the promise of the POLST Paradigm for patients approaching the end of life.
- Researchers 18,000 death records of individuals having a valid POLST form in the Oregon POLST Registry who had died of natural causes in Oregon between 2010 and 2011.
- The study compared the treatment wishes recorded on the patient’s POLST Form to their location of death. The authors found that:
- 6.4% of patients who had a POLST Form specifying Comfort Measures Only treatment wishes died in a hospital
- 22.4% for patients who wished for Limited Additional Interventions died in a hospital
- 44.2% of patients whose POLST specified wishes for Full Treatment died in a hospital
- 34.2% of patients without a POLST Form died in a hospital
- This pattern holds true for all 10 of the most common causes of death.
- POLST is not just a form; it is a process. Among other variables, a properly implemented POLST Program includes strong education, outreach and quality assurance elements in place.
To access the NPPTF Press Release, click here.
To access the OHSU Press Release, click here.
To access the article in JAGS, click here.
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