OBJECTIVES: To evaluate whether terminal care was consistent with Physician
Orders for Life-Sustaining Treatment (POLST), a preprinted and signed doct
or's order specifying treatment instructions in the event of serious illnes
s for CPR, levels of medical intervention, antibiotics, IV fluids, and feed
ing tubes.
DESIGN: Retrospective chart review.
SETTING: ElderPlace, a Program of All-Inclusive Care for the Elderly (PACE)
site in Portland, Oregon.
PARTICIPANTS: All ElderPlace participants who died in 1997 were eligible (n
=58). Reasons for exclusion were no POLST (1), missing POLST (1), and insu
fficient documentation of care (2).
MEASUREMENTS: POLST instructions for each participant and whether or not ea
ch of the treatments addressed by the POLST was administered in the final 2
weeks of life.
RESULTS: The POLST specified "do not resuscitate" for 50 participants (93%)
; CPR use was consistent with these instructions for 49 participants (91%).
"Comfort care" was the designated level of medical intervention in 13 case
s, "limited interventions" in 18, "advanced interventions;" in 18, and "ful
l interventions" in 5. Interventions administered were at the level specifi
ed in 25 cases (46%); at a less invasive level in 18 (33%), and at a more i
nvasive level in 11 (20%). Antibiotic administration was consistent with PO
LST instructions for 86% of 28 subjects who had infections in the last 2 we
eks of life, and less invasive for 14%. Care matched POLST instructions in
84% of cases for TV fluids and 94% for feeding tubes.
CONCLUSIONS: POLST completion in ElderPlace exceeds reported advance direct
ive rates. Care matched POLST instructions for CPR, antibiotics, TV fluids,
and feeding tubes more consistently than previously reported for advance d
irective instructions. Medical intervention level was consistent with POLST
instructions for less than half the participants, however. We conclude tha
t the POLST is effective for limiting the use of some life-sustaining inter
ventions, but that the factors that lead physicians to deviate from patient
s' stated preferences merit further investigation.