By Judy Citko Thomas, J.D. | @JudyThomasJD
Chair, National POLST Paradigm Task Force
Executive Director, Coalition for Compassionate Care of California


American Geriatrics Society coverA new study published in the Journal of American Geriatrics Society shows that participating in the Physician Orders for Life-Sustaining Treatment (POLST) program can effectively influence the care patients receive at the end of life. This is the first study we are aware of that looks at the association between preferences expressed in POLST orders and where people ultimately die.

Study details

The study, “Association between Physician Orders for Life-Sustaining Treatment for Scope of Treatment and in-Hospital Death in Oregon,” looks at the death records of 58,000 Oregon residents who died of natural causes in 2010 and 2011, and compares location of death with the medical treatment patients indicated on their POLST. Of the 58,000 death records, nearly 18,000 could be matched with a POLST in the Oregon POLST registry.

Only 6.4 percent of patients who specified “comfort measures only” orders on their POLST died in a hospital, while 44.2 percent of patients who chose “full treatment” died in a hospital. Additionally, 34.2 percent of people with no POLST form died in a hospital.

This study shows patients’ wishes are being matched with how they die. Essentially, if a patient said they wanted every intervention, they were more likely to die in a hospital than someone without a POLST form.

The connection to POLST in California

In 2012, the California HealthCare Foundation published a study called “Snapshot Final Chapter: Californians’ Attitudes and Experiences with Death and Dying,” and discovered that 70 percent of Californians would prefer to die at home. However, only 32 percent of deaths occured at home, while 42 percent occured in a hospital, and 18 percent in a nursing home.

The “Association between Physician Orders for Life-Sustaining Treatment for Scope of Treatment and in-Hospital Death in Oregon” study clearly shows there is a strong correlation between POLST and location of death, and illustrates that POLST is the best choice patients can make to remain in control of medical care they receive toward the end of life.

POLST is one of the most powerful tools available to make healthcare wishes known, even when patients are unable to speak for themselves.

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