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Putting Dying Wishes In Medical Record Helps Them Happen

This piece was first published in Reuters Health. LMM President Randi Belisomo is a contributor.

When patients’ end-of-life preferences are entered as instructions in their medical record, their wishes are more likely to be honored, a new study suggests.

The study was done in Oregon, one of two states with an end-of-life planning program called POLST (Physician Orders for Life-Sustaining Treatment).

“POLST is not for everyone. Only patients with serious illness or frailty should have a POLST form,” the program’s website notes.

polst-largeBut for those patients, “POLST records and honors wishes in a way that (medical professionals understand) and can implement across settings of care,” said Dr. Susan Tolle, an internist at Oregon Health and Science University in Portland and the study’s senior author.

Bright pink POLST forms are medical orders signed by physicians, nurse practitioners or physician assistants after discussions with patients about preferred treatment plans.

Tolle’s team studied death records of 58,000 people who died of natural causes in 2010 and 2011. About 30 percent had copies of their POLST form in a state-wide registry. The researchers compared the location of death on death records to POLST patient preferences.

“Although it is probably more important how you die than where you die, where you die can strongly affect how you die,” they write in the Journal of the American Geriatrics Society.

POLST forms don’t let patients specify where they prefer to die. Instead, the forms include three order sets that could impact location. More than two thirds of patients with POLST forms had chosen the first option: “prefers no transfer to hospital for life-sustaining treatments . . . transfer if comfort needs cannot be met in current location.”

Slightly more than a quarter chose the second option: “transfer to hospital if indicated . . . generally avoid the intensive care unit.”

Only six percent chose full treatment: “transfer to hospital and/or intensive care unit if indicated.”

One limitation of the study is that for people who died without a POLST form in the registry, there was no way to know what their preferences would have been. Also, the results would have been more reliable if everyone had been randomly assigned to a POLST or no-POLST group.

Still, the researchers believe, their findings suggest POLST forms made it more likely that patients’ wishes would be carried out.

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