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Filling Out Special Form Results in Desired Treatment in Final Days, According to Research on Oregon Deaths

By Laura Landro, Wall Street Journal
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Patients who document their end-of-life wishes using a special medical form get the specific care they want in their final days, according to a study published online in the Journal of the American Geriatrics Society.

The study by researchers at Oregon Health & Science University looked at the growing use of the voluntary form, called Physician Orders for Life-Sustaining Treatment, or POLST. The document lets patients request or refuse certain medical treatments such as CPR or intensive care. The study is the largest on the topic so far and the first to look at preferences stated in the form and where people actually die.

POLST programs have been adopted or are in development in 43 states. Proponents say that in addition to giving patients a voice in the face of advanced illness, they can help trim the nation’s bill for costly interventions that don’t extend life for patients who don’t want them. However, the programs remain controversial with some groups in the often-fraught national debate about end-of-life care.

The researchers examined death records for 58,000 people who died of natural causes in 2010 and 2011 in Oregon, where the POLST approach was developed in 1991 and which has the most comprehensive data on its use. Nearly 18,000 of the patients, or roughly 30%, had such forms on file at time of death. In comparing the location of death with the medical treatment people requested on their forms, only 6.4% of patients who specified “comfort measures only,” or allowing for a natural death while relieving pain and suffering, died in a hospital. Meanwhile, 22.4% of patients who chose “limited additional interventions” died in a hospital and 44.2% of patients who chose “full treatment” died there. Of people with no such form, 34.2% died in a hospital.

“We think almost everyone in our study who wanted to be with family and avoid an unwanted terminal hospitalization, as long as their comfort could be managed, got their wish,” said Susan Tolle, senior author of the study and director of the Center for Ethics in Health Care at the university. “There is a remarkable association between where you die and the orders selected on your POLST form.”

Carlos Rivera, 72 years old, survived a heart attack at 50 and was resuscitated by emergency medical personnel. But with advanced heart disease, he said he wouldn’t want to repeat the experience and signed a POLST form that includes a do-not-resuscitate order. “It would take the load off my family and relieve them of fighting over what to do,” said Mr. Rivera, who retired as a community agent in the Portland school system. “And people have the right to determine their own destiny.”

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