How well do POLST forms assure that patients get the end-of-life care they requested?
Q: How well do POLST forms assure that patients get the end-of-life care they requested? A: quite well, for cardiopulmonary resuscitation (CPR). Most patients (91%-100%) who select “do not resuscitate” (DNR) on their physician’s orders for life-sustaining treatment (POLST) forms are allowed a natural death without attempted CPR across a variety of settings (community, skilled nursing facilities, emergency medical services, and hospice). Few patients (6%) who select “comfort measures only” die in the hospital, whereas more (22%) who choose “limited interventions,” and still more (34%) without a POLST form, die in the hospital (strength of recommendation [SOR]: B, large, consistent cross-sectional and cohort studies). Most patients (84%) who select “attempt resuscitation” receive resuscitation for out-of-hospital cardiac arrest in emergency services settings (SOR: B, small retrospective cohort study). POLST orders declining other services (intravenous fluids, intensive care, intubation, feeding tubes) are carried out in most (84%-100%) cases. POLST orders regarding antibiotic treatments are less effectively implemented (SOR: B, moderate-sized retrospective chart review).
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