POLST Registration and Associated Outcomes Among Veterans With Advanced-Stage Lung Cancer.
Shannon M Nugent, Christopher G Slatore, Linda Ganzini and 4 others
PMID 30700127WHAT IT FOUND
Veterans with advanced lung cancer who had a registered POLST were more likely to enter hospice and less likely to die in a VA facility, but registration was uncommon and often only 7 weeks before death.
Key findings
01Only 22% of the cohort had a registered POLST.
02In adjusted models, registered POLST was associated with increased hospice enrollment (adjusted odds ratio 2.37) and decreased likelihood of death in a VA facility (adjusted odds ratio 0.27).
03Median time from POLST completion to death was 7.0 weeks.
STILL TO COME
How it was doneWhat they foundWhat it means for RNs
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What it does not show
Because this was an observational comparison, unmeasured confounding may explain the associations. Deaths outside VA could not be confirmed as non-acute settings, so place of death was not fully known. The study looked at registered POLST forms, not completed forms that were never registered. Other advance care planning documents were not studied. The sample was limited to Veterans diagnosed or treated within the VA and living in Oregon. The small number of people with second POLST forms and the small subgroup who died in a VA facility made those findings unstable.
Declared interests
The authors declared no potential conflicts of interest.
The easy way to misread this
Do not read the POLST associations as proof that registering a POLST caused better end-of-life care. This was an observational comparison, and Veterans with a registered POLST had higher income and longer median time between diagnosis and death.