Research Article
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Published Online: 1 November 2010

Use of the Physician Orders for Life-Sustaining Treatment (POLST) Paradigm Program in the Hospice Setting

Publication: Journal of Palliative Medicine
Volume 12, Issue Number 2

Abstract

Background: The Physician Orders for Life-Sustaining Treatment (POLST) Paradigm Program was designed to ensure the full range of patient treatment preferences are honored throughout the health care system. Data are lacking about the use of POLST in the hospice setting.
Objective: To assess use of the POLST by hospice programs, attitudes of hospice personnel toward POLST, the effect of POLST on the use of life-sustaining treatments, and the types of treatments options selected by hospice patients.
Design: A telephone survey was conducted of all hospice programs in three states (Oregon, Wisconsin, and West Virginia) to assess POLST use. Staff at hospices reporting POLST use (n = 71) were asked additional questions about their attitudes toward the POLST. Chart reviews were conducted at a subsample of POLST-using programs in Oregon (n = 8), West Virginia (n = 5), and Wisconsin (n = 2).
Results: The POLST is used widely in hospices in Oregon (100%) and West Virginia (85%) but only regionally in Wisconsin (6%). A majority of hospice staff interviewed believe the POLST is useful at preventing unwanted resuscitation (97%) and at initiating conversations about treatment preferences (96%). Preferences for treatment limitations were respected in 98% of cases and no one received unwanted cardiopulmonary resuscitation (CPR), intubation, intensive care, or feeding tubes. A majority of hospice patients (78%) with do-not-resuscitate (DNR) orders wanted more than the lowest level of treatment in at least one other category such as antibiotics or hospitalization.
Conclusions: The POLST is viewed by hospice personnel as useful, helpful, and reliable. It is effective at ensuring preferences for limitations are honored. When given a choice, most hospice patients want the option for more aggressive treatments in selected situations.

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Information & Authors

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Published In

cover image Journal of Palliative Medicine
Journal of Palliative Medicine
Volume 12Issue Number 2February 2009
Pages: 133 - 141
PubMed: 19207056

History

Published online: 1 November 2010
Published in print: February 2009

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Susan E. Hickman
School of Nursing, School of Medicine, Oregon Health & Science University, Portland, Oregon.
Christine A. Nelson
School of Nursing, School of Medicine, Oregon Health & Science University, Portland, Oregon.
Alvin H. Moss
School of Medicine, West Virginia University, Morgantown, West Virginia.
Bernard J. Hammes
Gundersen Lutheran, La Crosse, Wisconsin.
Allison Terwilliger
School of Nursing, School of Medicine, Oregon Health & Science University, Portland, Oregon.
Ann Jackson
Oregon Hospice Association, Portland, Oregon.
Susan W. Tolle
Center for Ethics in Health Care, Oregon Health & Science University, Portland, Oregon.

Notes

Address reprint requests to:Susan E. Hickman, Ph.D.School of NursingOregon Health & Science University3455 SW U.S. Veterans Hospital RoadSNORDPortland, OR 97239E-mail: [email protected]

Author Disclosure Statement

No competing financial interests exist.

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