West Virginia POLST Paradigm Program (POST) affects place of death for advanced cancer patients

On February 24th, 2017, Alvin (“Woody”) Moss, MD, gave a presentation on recent POLST research at the American Academy of Hospice and Palliative Medicine Annual Assembly in Phoenix, Arizona. Dr. Moss presented study findings based on data from the the West Virginia POST Registry (POST, or the Physician Orders for Scope of Treatment, is West Virginia’s POLST Paradigm Program). Study authors included Moss and coauthors Sandra Pedraza, MD, Stacey Culp, PhD, Mark Knestrick, MD, PharmD, and Evan Falkenstine, BS.

In summary:

Advanced cancer patients who had died with POST Forms or advance directives in the West Virginia e-Directive Registry were the subjects of the study. Compared to patients with advance directives, patients with POST Forms were more likely to die outside the hospital (OHD) and to have been admitted to hospice. The odds of OHD for patients with POST Forms were 2.33 times those of patients with ADs. The odds of being admitted to hospice for patients with POST Forms were 2.69 times those of patients with ADs. The authors hypothesize that these differences were found because completion of a POST Form requires an end-of-life care conversation with a clinician (physician or advanced practice registered nurse) whereas completion of an advance directive does not.


West Virginians have had better access to care since June 2016, when new laws lifted some restrictions on advanced practice registered nurses (APRNs). Now that APRNs may sign the forms that indicate preferences for end-of-life care, more West Virginians have been able to make their wishes clear. APRNs have signed 14 percent of the documents (POST Forms, Do-Not-Resuscitate cards, and Advance Directives) submitted to the West Virginia e-Directive Registry.


» Read more about the West Virginia Center for End-of-Life Care

» People who have a terminal illness often prefer to spend their last days at home, rather than a hospital (story from West Virginia Public Radio about WV POST).

» Read more: Terminally Ill and Want to Die at Home? Fill Out This Form(WV Public Broadcasting)

» Under new legislation, advanced practice nurses signing POST forms (Charleston Gazette-Mail).

» Association of POST Form Use with Quality End-of-Life Care Metrics in Cancer Patients: Update from the West Virginia Registry (FR440B).