To What Extent Do Physician Orders for Life-Sustaining Treatment (POLST) Reflect Patients' Preferences for Care at the End of Life?
Gustavo B Lovadini, Fernanda B Fukushima, Joao F L Schoueri and 11 others
PMID 33246840WHAT IT FOUND
POLST orders mostly matched patients' separately documented end-of-life preferences, but 7 of 62 patients had at least one disagreement.
Check POLST orders against current preferences and revisit them as care needs change.
Key findings
01POLST orders agreed highly with preferences documented in a separate advance care planning conversation, but 7 of 62 patients had at least one discordant order.
02Disagreements about CPR occurred in only 2 of 62 patients.
03No examined baseline variable, including interview order, significantly predicted disagreement between the two documents.
STILL TO COME
How it was doneWhat they foundWhat it means for RNs
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What it does not show
The study included only a small number of inpatients at one Brazilian university hospital, so it may not apply to other settings or populations. The advance care planning conversations were conducted by specially trained researchers, so agreement may be better than in usual practice. The researchers could not ask patients why the two documents differed, so it is unclear whether the POLST form or the separate conversation was more accurate.
Declared interests
The authors declared no conflicts of interest.
The easy way to misread this
Do not conclude that POLST orders always reflect current patient preferences. Seven of 62 patients had at least one order that disagreed with the separately documented preference, so the order still needs confirmation.