Improving Communication of End-of-Life Treatment Preferences

Hickman SE, Nelson CA, Perrin NA, Moss AH, Hammes BJ, Tolle SW. Journal of the American Geriatrics Society. 2010 July;58:1241–1248.

• Many individuals and their families still struggle with a lack of continuity of care and poor communication with health care practitioners about their treatment wishes, especially at the end-of-life.
• The Physician Orders for Life-Sustaining Treatment (POLST) program consists of a standardized, automatically transferred form on which patient preferences are listed as physician orders for cardiopulmonary resuscitation (CPR); medical interventions such as comfort measures (non-life-sustaining measures to relieve pain and suffering), limited intervention or full treatment; use of antibiotics; and tube feeding.
• Using data from over 1,700 living and deceased long-stay nursing facility residents in Oregon, Wisconsin, and West Virginia, this study examined the effectiveness of the POLST program compared with traditional practices such as Do-Not-Resuscitate (DNR) orders. The study, led by Dr. Susan Hickman of the schools of nursing at Indiana University and Oregon Health & Science University, was the first to directly compare the use of POLST to traditional practices.
• The study found that those residents with POLST forms were less likely to receive unwanted life sustaining treatment when compared with those with traditional DNR orders.
• The presence of a POLST order did not impact the degree of comfort care received by the residents as indicated by no significant difference in reported symptom frequency or in the level of symptom management received.
• This study underscores the importance of identifying effective ways to communicate individual preferences for life-sustaining care. Health care professionals can use a program such as POLST to help individuals make more informed choices about the type and level of end-of-life care they receive.