Physician Orders for Life-Sustaining Treatment Form Use and End-of-Life Quality-of-Care Metrics in Cancer Patients

Key Points

  • Out-of-hospital death occurred for 85.7% of patients with POLST forms vs 72.0% of those with only advance directives.
  • Hospice admission occurred for 49.9% vs 27.0%, respectively.

In a study reported in the Journal of Oncology Practice, Pedraza et al found that patients with advanced cancer who had Physician Orders for Life-Sustaining Treatment (POLST) forms in place were more likely to have hospice admission and death out of the hospital than those with only advance directives.

Study Details

The study involved 2,159 patients in West Virginia with advance directives or POLST forms in the West Virginia e-Directive Registry who died of cancer between January 2011 and February 2016. Data from the registry were merged with data from the Vital Registration Office (date, site, and cause of death). The primary outcome measures were out-of-hospital death and hospice admission.

Outcomes

Among all patients, 1,108 (51.3%) had only advance directives, 756 (35%) had only POLST forms, and 295 (13.7%) had both. Those with both were considered to be in the POLST group. POLST forms were completed a mean of 3.0 months before death, and advance directives were completed a mean of 8.6 months before death.

The percentage of patients with out-of-hospital death was 85.7% among patients with POLST forms vs 72.0% for those with only advance directives (P < .001; odds = 2.33 in favor of POLST forms). The percentage of patients admitted to hospice was 49.9% for those with POLST forms vs 27.0% for those with only advance directives (P < .001; odds = 2.69 in favor of POLST forms).

The investigators concluded: “Advance care planning with completion of POLST forms compared with [advance directives] in patients with advanced cancer was associated with two quality end-of-life care metrics: [out-of-hospital death] and hospice admission. Our study suggests that goals-of-care discussions including POLST form completion may improve end-of-life care for patients with advanced cancer.”

The study was supported in part by the Mei-Ying Huang Research Fund of the West Virginia University Center for Health Ethics and Law.

Alvin H. Moss, MD, of West Virginia University School of Medicine, is the corresponding author of the Journal of Oncology Practice article.

The content in this post has not been reviewed by the American Society of Clinical Oncology, Inc. (ASCO®) and does not necessarily reflect the ideas and opinions of ASCO®.


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