Use of the physician orders for life-sustaining treatment program in the clinical setting

A systematic review of the literature

Susan Hickman, Elisabeth Keevern, Bernard J. Hammes

Research output: Contribution to journalArticle

68 Citations (Scopus)

Abstract

The Physician Orders for Life-Sustaining Treatment (POLST) form is a palliative care tool that contains standardized, actionable medical orders. It is designed to ensure that patient treatment preferences are elicited, communicated, and honored throughout the healthcare system. A systematic review of the literature was conducted to evaluate what is currently known about the POLST program and identify directions for future research. Twenty-three research studies focused on POLST use in the clinical setting were identified. A majority of studies have been conducted all or in part in Oregon, with chart review the most frequently used methodology. Research suggests that POLST is most commonly used in older, white patients who are near the end of life. A nonphysician facilitator usually prepares the POLST form for the physician to review and sign. The orders documented on POLST reflect a wide degree of individualization, with only approximately one-third of patients having orders reflecting the lowest level of treatment in all POLST form sections. Clinicians have generally positive attitudes regarding use of POLST yet report a wide range of challenges. POLST alters treatment in a way that is consistent with orders. However, evidence that POLST reflects patient or surrogate treatment preferences is lacking. Research is needed to evaluate the quality of POLST decisions, explore the experiences of patients and their surrogates, develop decision-support tools, improve clinician education, and assess the effect of POLST on care outcomes through intervention and population-based studies.

Original languageEnglish
Pages (from-to)341-350
Number of pages10
JournalJournal of the American Geriatrics Society
Volume63
Issue number2
DOIs
StatePublished - Feb 1 2015

Fingerprint

Physicians
Therapeutics
Research
Patient Preference
Palliative Care
Delivery of Health Care
Education

Keywords

  • advance care planning
  • end of life
  • ethics

ASJC Scopus subject areas

  • Geriatrics and Gerontology

Cite this

Use of the physician orders for life-sustaining treatment program in the clinical setting : A systematic review of the literature. / Hickman, Susan; Keevern, Elisabeth; Hammes, Bernard J.

In: Journal of the American Geriatrics Society, Vol. 63, No. 2, 01.02.2015, p. 341-350.

Research output: Contribution to journalArticle

@article{39b2b377437847a7b0b19dab09023e43,
title = "Use of the physician orders for life-sustaining treatment program in the clinical setting: A systematic review of the literature",
abstract = "The Physician Orders for Life-Sustaining Treatment (POLST) form is a palliative care tool that contains standardized, actionable medical orders. It is designed to ensure that patient treatment preferences are elicited, communicated, and honored throughout the healthcare system. A systematic review of the literature was conducted to evaluate what is currently known about the POLST program and identify directions for future research. Twenty-three research studies focused on POLST use in the clinical setting were identified. A majority of studies have been conducted all or in part in Oregon, with chart review the most frequently used methodology. Research suggests that POLST is most commonly used in older, white patients who are near the end of life. A nonphysician facilitator usually prepares the POLST form for the physician to review and sign. The orders documented on POLST reflect a wide degree of individualization, with only approximately one-third of patients having orders reflecting the lowest level of treatment in all POLST form sections. Clinicians have generally positive attitudes regarding use of POLST yet report a wide range of challenges. POLST alters treatment in a way that is consistent with orders. However, evidence that POLST reflects patient or surrogate treatment preferences is lacking. Research is needed to evaluate the quality of POLST decisions, explore the experiences of patients and their surrogates, develop decision-support tools, improve clinician education, and assess the effect of POLST on care outcomes through intervention and population-based studies.",
keywords = "advance care planning, end of life, ethics",
author = "Susan Hickman and Elisabeth Keevern and Hammes, {Bernard J.}",
year = "2015",
month = "2",
day = "1",
doi = "10.1111/jgs.13248",
language = "English",
volume = "63",
pages = "341--350",
journal = "Journal of the American Geriatrics Society",
issn = "0002-8614",
publisher = "Wiley-Blackwell",
number = "2",

}

TY - JOUR

T1 - Use of the physician orders for life-sustaining treatment program in the clinical setting

T2 - A systematic review of the literature

AU - Hickman, Susan

AU - Keevern, Elisabeth

AU - Hammes, Bernard J.

PY - 2015/2/1

Y1 - 2015/2/1

N2 - The Physician Orders for Life-Sustaining Treatment (POLST) form is a palliative care tool that contains standardized, actionable medical orders. It is designed to ensure that patient treatment preferences are elicited, communicated, and honored throughout the healthcare system. A systematic review of the literature was conducted to evaluate what is currently known about the POLST program and identify directions for future research. Twenty-three research studies focused on POLST use in the clinical setting were identified. A majority of studies have been conducted all or in part in Oregon, with chart review the most frequently used methodology. Research suggests that POLST is most commonly used in older, white patients who are near the end of life. A nonphysician facilitator usually prepares the POLST form for the physician to review and sign. The orders documented on POLST reflect a wide degree of individualization, with only approximately one-third of patients having orders reflecting the lowest level of treatment in all POLST form sections. Clinicians have generally positive attitudes regarding use of POLST yet report a wide range of challenges. POLST alters treatment in a way that is consistent with orders. However, evidence that POLST reflects patient or surrogate treatment preferences is lacking. Research is needed to evaluate the quality of POLST decisions, explore the experiences of patients and their surrogates, develop decision-support tools, improve clinician education, and assess the effect of POLST on care outcomes through intervention and population-based studies.

AB - The Physician Orders for Life-Sustaining Treatment (POLST) form is a palliative care tool that contains standardized, actionable medical orders. It is designed to ensure that patient treatment preferences are elicited, communicated, and honored throughout the healthcare system. A systematic review of the literature was conducted to evaluate what is currently known about the POLST program and identify directions for future research. Twenty-three research studies focused on POLST use in the clinical setting were identified. A majority of studies have been conducted all or in part in Oregon, with chart review the most frequently used methodology. Research suggests that POLST is most commonly used in older, white patients who are near the end of life. A nonphysician facilitator usually prepares the POLST form for the physician to review and sign. The orders documented on POLST reflect a wide degree of individualization, with only approximately one-third of patients having orders reflecting the lowest level of treatment in all POLST form sections. Clinicians have generally positive attitudes regarding use of POLST yet report a wide range of challenges. POLST alters treatment in a way that is consistent with orders. However, evidence that POLST reflects patient or surrogate treatment preferences is lacking. Research is needed to evaluate the quality of POLST decisions, explore the experiences of patients and their surrogates, develop decision-support tools, improve clinician education, and assess the effect of POLST on care outcomes through intervention and population-based studies.

KW - advance care planning

KW - end of life

KW - ethics

UR - http://www.scopus.com/inward/record.url?scp=84923248691&partnerID=8YFLogxK

UR - http://www.scopus.com/inward/citedby.url?scp=84923248691&partnerID=8YFLogxK

U2 - 10.1111/jgs.13248

DO - 10.1111/jgs.13248

M3 - Article

VL - 63

SP - 341

EP - 350

JO - Journal of the American Geriatrics Society

JF - Journal of the American Geriatrics Society

SN - 0002-8614

IS - 2

ER -