An Integrative Review of the State of POLST Science: What Do We Know and Where Do We Go?
Elizabeth E Umberfield, Matthew C Fields, Rachel Lenko and 8 others
PMID 38395413WHAT IT FOUND
Portable medical orders called POLST were associated with treatment matching documented orders and more preference documentation, but the evidence came only from observational studies, so it cannot prove they improve patient outcomes.
Key findings
01The review included 94 POLST studies, but found no randomized controlled trials or systematic reviews with meta-analysis.
02In 15 studies comparing POLST users with non-users, 40 of 70 outcomes were statistically significant.
03Quality of Care outcomes were the most often significant (15; 79%), including treatment concordant with documented POLST orders (14; 78%).
STILL TO COME
How it was doneWhat they foundWhat it means for RNs
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What it does not show
The review found no randomized controlled trials or systematic reviews with meta-analysis, so it cannot show that POLST causes better outcomes. Most included studies were observational, and only 15 had a comparison group of non-POLST users. In many comparisons, POLST use was not controlled, and some studies did not adjust for differences between groups. Searches were limited to PubMed and CINAHL, so relevant studies in other databases or using only state acronyms may have been missed. The review rated studies only by design level, not by detailed methodological quality, because the studies were very heterogeneous. Many utilization studies grouped all POLST users together, regardless of the specific orders, which may have diluted effects. Important outcomes such as patient or surrogate satisfaction, readiness, self-efficacy, and knowledge were not measured in comparison studies. State-level resources and implementation support may have affected outcomes, but this was not assessed.
Declared interests
The paper is marked as NIH extramural research support. No conflicts of interest statement is provided in the supplied article.
The easy way to misread this
Do not conclude that POLST causes better outcomes. The review found no randomized controlled trials, and the significant results came from observational comparisons, so they show associations only.