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Medline ® Abstract for Reference 68

of 'Palliative care: Medically futile and potentially inappropriate therapies of questionable benefit'

Association between Physician Orders for Life-Sustaining Treatment for Scope of Treatment and in-hospital death in Oregon.
Fromme EK, Zive D, Schmidt TA, Cook JN, Tolle SW
J Am Geriatr Soc. 2014 Jul;62(7):1246-51. Epub 2014 Jun 9.
OBJECTIVES: To examine the relationship between Physician Orders for Life-Sustaining Treatment (POLST) for Scope of Treatment and setting of care at time of death.
DESIGN: Cross-sectional.
SETTING: Oregon in 2010 and 2011.
PARTICIPANTS: People who died of natural causes.
MEASUREMENTS: Oregon death records containing cause and location of death were matched with POLST orders for people with a POLST form in the Oregon POLST registry. Logistic regression was used to measure the association between POLST orders and location of death.
RESULTS: Of 58,000 decedents, 17,902 (30.9%) had a POLST form in the registry. Their orders for Scope of Treatment were comfort measure only, 11,836 (66.1%); limited interventions, 4,787 (26.7%); and full treatment, 1,153 (6.4%). Comfort measures only (CMO) orders advise avoiding hospitalization unless comfort cannot be achieved in the current setting; 6.4% of participants with POLST CMO orders died in the hospital, compared with 44.2% of those with orders for full treatment and 34.2% for those with no POLST form in the registry. In the logistic regression, the odds of dying in the hospital of those with an order for limited interventions was 3.97 times as great (95% CI = 3.59-4.39) as of those with a CMO order, and the odds of those with an order for full treatment was 9.66 times as great (95% CI = 8.39-11.13).
CONCLUSIONS: The association with numbers of deaths in the hospital suggests that end-of-life preferences of people who wish to avoid hospitalization as documented in POLST orders are honored.
Division of Hematology and Medical Oncology, Oregon Health&Science University, Portland, Oregon.