More Oregonians sharing end-of-life wishes with POLST

November 28, 2018

More Oregonians are making their end-of-life wishes known through forms known as Physician Order for Life-Sustaining Treatment, or POLST, according to research published in the Journal of Palliative Medicine.

After comparing a database of Oregon POLST forms and state death certificates, OHSU researchers found 45 percent of Oregonians who died between 2015 and 2016 had filled out a POLST form, compared with about 31 percent between 2010-11. Oregon first started using POLST forms in the 1990s, but a central, statewide POLST database wasn't established until 2009.

Researchers also found how people are using the form is changing. The length of time between when people filled out the form and died increased from an average of five weeks to 21 weeks.

We learned that patients with Alzheimer's and Parkinson's often complete POLST forms earlier in their disease then their final year of life, according to study co-author Susan Tolle, M.D., director of the OHSU Center for Ethics in Health Care and professor of medicine (general internal medicine and geriatrics) in the OHSU School of Medicine.

While the oldest Oregonians increased their POLST usage the most, there was also a rise in POLST use by middle-aged Oregonians. The total number of people aged 95 and older who died and used POLST forms increased 83 percent between 2010-11 and 2015-16, while those aged 45 to 64 used the forms about 19 percent more during the same timeframe.

The data also indicated more Oregonians who die are indicating via POLST that they want more extensive medical care. For example, about 13 percent of POLST forms completed by those who died between 2015-16 requested CPR, compared with about 8 percent in 2010-11. And about 11 percent in 2015-16 requested full medical treatment, compared with about 6 percent in 2010-11. Other options on the form include declining resuscitation and requesting limited treatment or comfort-focused care.

The POLST form was created after a group of ethics leaders convened by OHSU to ensure the end-of-life health care wishes of those with advanced illness or frailty would be followed. POLST-like programs have been adopted or are in development in all 50 states and Washington, D.C., and they are associated with reducing unwanted hospitalizations near the end of life.

Separate from POLST, advanced directive forms share a patient's end-of-life philosophy and preferences, but they do not provide actionable medical orders for emergency medical service personnel such as EMTs to follow.
The study's authors receive support from The Denison Family Fund of the Oregon Community Foundation, The Gordon and Betty Moore Foundation, The John A. Hartfoard Foundation and The Kinsman Foundation.

Related OHSU news stories:


Oregon Health & Science University

Related Health Care Articles from Brightsurf:

Study evaluates new World Health Organization Labor Care Guide for maternity care providers
The World Health Organization developed the new Labor Care Guide to support clinicians in providing good quality, women-centered care during labor and childbirth.

Six ways primary care "medical homes" are lowering health care spending
New analysis of 394 U.S. primary care practices identifies the aspects of care delivery that are associated with lower health care spending and lower utilization of emergency care and hospital admissions.

Modifiable health risks linked to more than $730 billion in US health care costs
Modifiable health risks, such as obesity, high blood pressure, and smoking, were linked to over $730 billion in health care spending in the US in 2016, according to a study published in The Lancet Public Health.

Spending on primary care vs. other US health care expenditures
National health care survey data were used to assess the amount of money spent on primary care relative to other areas of health care spending in the US from 2002 to 2016.

MU Health Care neurologist publishes guidance related to COVID-19 and stroke care
A University of Missouri Health Care neurologist has published more than 40 new recommendations for evaluating and treating stroke patients based on international research examining the link between stroke and novel coronavirus (COVID-19).

Large federal program aimed at providing better health care underfunds primary care
Despite a mandate to help patients make better-informed health care decisions, a ten-year research program established under the Affordable Care Act has funded a relatively small number of studies that examine primary care, the setting where the majority of patients in the US receive treatment.

International medical graduates care for Medicare patients with greater health care needs
A study by a Massachusetts General Hospital research team indicates that internal medicine physicians who are graduates of medical schools outside the US care for Medicare patients with more complex medical needs than those cared for by graduates of American medical schools.

The Lancet Global Health: Improved access to care not sufficient to improve health, as epidemic of poor quality care revealed
Of the 8.6 million deaths from conditions treatable by health care, poor-quality care is responsible for an estimated 5 million deaths per year -- more than deaths due to insufficient access to care (3.6 million) .

Under Affordable Care Act, Americans have had more preventive care for heart health
By reducing out-of-pocket costs for preventive treatment, the Affordable Care Act appears to have encouraged more people to have health screenings related to their cardiovascular health.

High-deductible health care plans curb both cost and usage, including preventive care
A team of researchers based at IUPUI has conducted the first systematic review of studies examining the relationship between high-deductible health care plans and the use of health care services.

Read More: Health Care News and Health Care Current Events is a participant in the Amazon Services LLC Associates Program, an affiliate advertising program designed to provide a means for sites to earn advertising fees by advertising and linking to