Skip to main page content
U.S. flag

An official website of the United States government

Dot gov

The .gov means it’s official.
Federal government websites often end in .gov or .mil. Before sharing sensitive information, make sure you’re on a federal government site.

Https

The site is secure.
The https:// ensures that you are connecting to the official website and that any information you provide is encrypted and transmitted securely.

Access keys NCBI Homepage MyNCBI Homepage Main Content Main Navigation
. 2009 Feb;12(2):133-41.
doi: 10.1089/jpm.2008.0196.

Use of the Physician Orders for Life-Sustaining Treatment (POLST) paradigm program in the hospice setting

Susan E Hickman  1 , Christine A Nelson, Alvin H Moss, Bernard J Hammes, Allison Terwilliger, Ann Jackson, Susan W Tolle
Affiliations

Use of the Physician Orders for Life-Sustaining Treatment (POLST) paradigm program in the hospice setting

Susan E Hickman et al. J Palliat Med. 2009 Feb.

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.

PubMed Disclaimer

Figures

FIG. 1.
FIG. 1.
2008 Oregon POLST form.
FIG. 1.
FIG. 1.
2008 Oregon POLST form.
See this image and copyright information in PMC

References

    1. Lorenz KA. Asch SM. Rosenfeld KE. Liu H. Ettner SL. Hospice admission practices; Where does hospice fit in the continuum of care? J Am Geriatr Soc. 2004;52:725–730. - PubMed
    1. Wright AA. Katz IT. Letting go of the rope—Aggressive treatment, hospice care, and open access. N Engl J Med. 2007;357:324–327. - PubMed
    1. Cintron A. Hamel MB. Davis R. Burns R. Phillips RS. McCarthy EP. Hospitalization of hospice patients with cancer. J Palliat Med. 2003;6:757–768. - PubMed
    1. Beach MC. Morrison RS. The effect of do-not-resuscitate orders on physician decision-making. J Am Geriatr Soc. 2002;50:2057–2061. - PubMed
    1. Holtzman J. Pheley AM. Lurie N. Changes in orders limiting care and the use of less aggressive care in nursing home population. J Am Geriatr Soc. 1994;42:275–279. - PubMed

Publication types