On the heels of my colleague James M. Berklan’s discussion about how little we know about our loved ones’ preferences for end-of-life care, there’s a sign of progress in Oregon.
It comes down to a form.
In 2010-2011, only a third of Oregonians died that year had filled out a Physician Order for Life-Sustaining Treatment (POLST) form, according to an analysis from the Journal of Palliative Medicine.
By 2015-2016, that had risen to 45%. Researchers looked at the database of state death certificates and Oregon POLST forms. While the form has been available for 25 years in Oregon, a statewide POLST database was not launched until 2009.
It is worth noting that we have to take everything in Oregon with a grain of salt, along with a whiff of its pine trees. In this case, we know from data published in the New England Journal of Medicine that Oregonians with serious illness or frailty are more likely to have their end-of-life wishes honored and less likely to be hospitalized. They are more likely to use home hospice services.
Still, the change can reflect some broader trends. For one, most states have increasing numbers of baby boomers, and people living over age 95. Those closing in on their centennial birthdays in Oregon increased their use of POLST forms by 83% over the five-year timeframe. Those between the ages of 45 to 64 increased their use of the form by 19%.
Interestingly, POLST can yield some surprises, such as who wants medical care. Around 13% of POLST form writers who died between 2015-2016 requested CPR, a jump from 8% five years earlier. Similarly, 11% requested “full medical treatment,” up 5% from the previous years.
Finally, those with Alzheimer’s and Parkinson’s are completing POLST forms earlier than in their final year of life, according to study co-author Susan Tolle, M.D. There are a slew of factors to consider here: One, better communication about the progression about these diseases, along with prompt diagnosis. Two, while there is no cure for either disease, Parkinson’s in particular has a variety of treatment options that may prolong life, but provoke a discussion about how much treatment the person wants.
The researchers also found that the length of time between when people filled out the form and died leapfrogged from an average of 5 weeks to 21 weeks. If you think about the things you’ll do in five weeks compared to five months, that’s a big difference.
The big takeaway for long-term care providers is making sure the correct residents are introduced to the form. In California, the form is part of the MDS. A 2016 analysis found that POLST use grew from 33% to 49% in 2011. Yet Tolle warned in a Health Affairs piece that no nursing home resident should feel pressured.
“The presumption that all nursing home residents need, or should be required to have, a POLST form is questionable,” she wrote, noting in particular that short-stay rehabilitation residents are expecting, hopefully correctly, that they are headed home. “Quality measures that count POLST form completion may result in undue pressure on patients or in form completion for the wrong patient population.”
But it’s clear that for the right patient population, the POLST form can be a huge help.
Follow Senior Editor Elizabeth Newman @TigerELN.