Purpose: Physician Orders for Life-Sustaining Treatment (POLST) form is a legal document for terminally ill patients to make medical decisions with physicians near the end-of-life. A multicenter prospective study was conducted to evaluate the feasibility of POLST administration in actual oncological practice.
Materials and methods: Patients with terminal cancer, age ≥ 20 years, and capable of communicating were eligible. The primary endpoint was the completion rate of POLST. Data about physicians' or patients' barriers were also collected.
Results: From June to December 2017, 336 patients from seven hospitals were eligible. Median patient age was 66 years (range, 20 to 94 years); 52.7% were male; and 60.4% had poor performance status. Primary cancer sites were hepato-pancreato-biliary (26.2%), lung (23.2%), and gastrointestinal (19.9%). Expected survival duration was 10.6±7.3 weeks, with 41.2% receiving hospice care, 37.9% showing progression after cancer treatment, and the remaining patients were under active treatment (15.8%) or initially diagnosed with terminal cancer (5.1%). POLST forms were introduced to 60.1% of patients, and 31.3% signed the form. Physicians' barriers were reluctance of family (49.7%), lack of rapport (44.8%), patients' denial of prognosis (34.3%), lack of time (22.7%), guilty feelings (21.5%), and uncertainty about either prognosis (21.0%) or the right time to discuss POLST (16.6%). The patients' barriers were the lack of knowledge/understanding of POLST (65.1%), emotional discomfort (63.5%), difficulty in decision-making (66.7%), or denial of prognosis (14.3%).
Conclusion: One-third of patients completed POLST forms, and various barriers were identified. To overcome such barriers, social engagement, education, and systematic support might be necessary.
Keywords: Feasibility; Physician Orders for Life-Sustaining Treatment; Terminal cancer.
Conflict of interest statement
Conflict of interest relevant to this article was not reported.
Association of Physician Orders for Life-Sustaining Treatment Form Use With End-of-Life Care Quality Metrics in Patients With CancerSL Pedraza et al. J Oncol Pract 13 (10), e881-e888. PMID 28727486.Advance care planning with completion of POLST forms compared with ADs in patients with advanced cancer was associated with two quality end-of-life care metrics: OHD and …
Timing of POLST Form Completion by Cause of DeathDM Zive et al. J Pain Symptom Manage 50 (5), 650-8. PMID 26162508.More than half of POLST forms were completed in the final two months of life. Cause of death influenced when POLST forms were completed. POLST forms changed in the two ye …
The Role of Advanced Practice Registered Nurses in the Completion of Physician Orders for Life-Sustaining TreatmentSA Hayes et al. J Palliat Med 20 (4), 415-419. PMID 27767363.More than 10% of Oregon POLST forms are signed by APRNs. Given the need for timely POLST form completion, ideally by a member of the interdisciplinary team who knows the …
Use of the Physician Orders for Life-Sustaining Treatment Program in the Clinical Setting: A Systematic Review of the LiteratureSE Hickman et al. J Am Geriatr Soc 63 (2), 341-50. PMID 25644280. - ReviewThe Physician Orders for Life-Sustaining Treatment (POLST) form is a palliative care tool that contains standardized, actionable medical orders. It is designed to ensure …
Physician-related Barriers to Communication and Patient- And Family-Centred Decision-Making Towards the End of Life in Intensive Care: A Systematic ReviewM Visser et al. Crit Care 18 (6), 604. PMID 25403291. - ReviewWe conclude that many physician-related barriers hinder adequate communication and shared decision-making in ICUs. Better physician education and palliative care guidelin …
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