Patients' End-of-Life Wishes Granted, Study Finds

Patients who document their end-of-life wishes using a special medical form get the specific care they want in their final days, according to a study published online in the Journal of the American Geriatrics Society. The study by researchers at Oregon Health & Science University looked at the growing use of the voluntary form, called Physician Orders for Life-Sustaining Treatment, or Polst. The document lets patients request or refuse certain medical treatments such as CPR or intensive care. The study is the largest on the topic so far and the first to look at preferences stated in the form and where people actually die.

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The researchers examined death records for 58,000 people who died of natural causes in 2010 and 2011 in Oregon, where the Polst approach was developed in 1991 and which has the most comprehensive data on its use. Nearly 18,000 of the patients, or roughly 30%, had such forms on file at time of death. In comparing the location of death with the medical treatment people requested on their forms, only 6.4% of patients who specified "comfort measures only," or allowing for a natural death while relieving pain and suffering, died in a hospital. Meanwhile, 22.4% of patients who chose "limited additional interventions" died in a hospital and 44.2% of patients who chose "full treatment" died there. Of people with no such form, 34.2% died in a hospital.

"We think almost everyone in our study who wanted to be with family and avoid an unwanted terminal hospitalization, as long as their comfort could be managed, got their wish," said Susan Tolle, senior author of the study and director of the Center for Ethics in Health Care at the university. "There is a remarkable association between where you die and the orders selected on your Polst form."

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Some organizations that oppose Polst forms say they pose unacceptable risks to patients' well-being, including Catholic bishops' groups in some states which have said that the forms conflict with church doctrine and ethical values. Wisconsin's Catholic bishops, for example, have published their own guidelines aimed at helping individuals convey their desires regarding health-care decision-making to align with church principles.

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Unlike an advance directive or living will, which are often recommended for healthy patients to make their end-of-life wishes known to loved ones, and which may designate a surrogate to make decisions, Polst forms are designed for seriously ill or frail patients whose health indicates that such decisions might need to be made in a relatively short time frame. Clinicians are encouraged to offer them to patients if they wouldn't be surprised to see them die within a year, and the forms are revocable at any time.

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http://online.wsj.com/articles/patients-end-of-life-wishes-granted-study-finds-1402285059