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Changes over time in the Oregon physician orders for life-sustaining treatment registry : a study of two decedent cohorts
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BACKGROUND: The Physician Orders for Life-Sustaining Treatment (POLST) began in Oregon in 1993 and has since spread nationally and internationally.
OBJECTIVES: Describe and compare demographics and POLST orders in two decedent cohorts: deaths in 2010-2011 (Cohort 1) and in 2015-2016 (Cohort 2).
DESIGN: Descriptive retrospective study.
SETTING/SUBJECTS: Oregon decedents with an active form in the Oregon POLST Registry.
MEASUREMENTS: Oregon death records were matched with POLST orders. Descriptive analysis and logistic regression models assess differences between the cohorts.
RESULTS: The proportion of Oregon decedents with a registered POLST increased by 46.6% from 30.9% (17,902/58,000) in Cohort 1 to 45.3% (29,694/65,458) in Cohort 2. The largest increase (83.3%) was seen in decedents 95 years or older with a corresponding 78.7% increase in those with Alzheimer's disease and dementia, while the interval between POLST form completion and death in these decedents increased from a median of 9-52 weeks. Although orders for do not resuscitate and other orders to limit treatment remained the most prevalent in both cohorts, logistic regression models confirm a nearly twofold increase in odds for cardiopulmonary resuscitation and full treatment orders in Cohort 2 when controlling for age, sex, race, education, and cause of death.
CONCLUSION: Compared with Cohort 1, Cohort 2 reflected several trends: a 46.6% increase in POLST Registry utilization most marked in the oldest old, substantial increases in time from POLST completion to death, and disproportionate increases in orders for more aggressive life-sustaining treatment. Based on these findings, we recommend testing new criteria for POLST completion in frail elders.
https://www.liebertpub.com/doi/pdf/10.1089/jpm.2018.0446
Voir la revue «JOURNAL OF PALLIATIVE MEDICINE, 22»
Autres numéros de la revue «JOURNAL OF PALLIATIVE MEDICINE»
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