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, 51 (4), 1632-1638

Feasibility Study of Physician Orders for Life-Sustaining Treatment for Patients With Terminal Cancer


Feasibility Study of Physician Orders for Life-Sustaining Treatment for Patients With Terminal Cancer

Ho Jung An et al. Cancer Res Treat.


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.


Fig. 1.
Fig. 1.
Patients’ diagram. POLST, Physician’s Order for Life-sustaining Treatment.

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    1. Korean Supreme Court . Withdrawing futile life-sustaining treatment. Seoul: Korean Supreme Court; 2009.
    1. Ministry of Health and Welfare . Act on hospice and palliative care and decisions on life-sustaining treatment for patients at the end of life. Sejong: Ministry of Health and Welfare; 2016.
    1. Royal College of Physicians . Advance care planning: concise guideline to good practice, No. 12. London: Royal College of Physicians; 2009.
    1. Houben CH, Spruit MA, Groenen MT, Wouters EF, Janssen DJ. Efficacy of advance care planning: a systematic review and meta-analysis. J Am Med Dir Assoc. 2014;15:477–89. - PubMed
    1. Keam B, Yun YH, Heo DS, Park BW, Cho CH, Kim S, et al. The attitudes of Korean cancer patients, family caregivers, oncologists, and members of the general public toward advance directives. Support Care Cancer. 2013;21:1437–44. - PubMed