Image of Susan E. Hickman, Ph.D.
Susan E. Hickman, Ph.D.

Nursing home residents who have Physician’s Orders for Life-Sustaining Treatment significantly increase the likelihood that their treatment preferences are known, a statewide facility study has shown.

POLST forms are designed for people with life-limiting conditions, such as advanced frailty, and summarize patient wishes as medical orders. POLST directions may be more specific than those of advance directives and do-not-resuscitate orders. During emergency situations and when a patient is incapacitated, they can help care providers answer questions about issues such as intubation, hospitalization and comfort-based care. 

Investigators interviewed 358 residents or their surrogates in 40 Indiana nursing facilities about their life-sustaining wishes. Some had POLST (275) and others did not (83). They then compared the treatment orders documented in medical records with residents’ current preferences. 

Agreement between the medical records and preferences was higher for residents with POLST (59%) than without POLST (35%). And when adjusted for resident, surrogate and facility characteristics, residents with POLST were three times more likely to have life-sustaining treatment orders that matched their current preferences, reported lead author Susan E. Hickman, Ph.D.

“Often, preferences are not communicated with providers, which can lead to more aggressive care than what the patient wanted,” said Hickman, of the Indiana University Center for Aging Research, Regenstrief Institute. “This research shows that POLST forms are effective at communicating current care preferences and increase the likelihood that treatments will match preferences.”

The COVID pandemic has prompted long-term care clinicians to endorse a national version of the form, which is widely used, but varies by state. “A form that is honored by all will reach its full value to patients,” said AMDA–The Society for Post-Acute and Long-Term Care Medicine in a July endorsement.

The study was published in the Journal of General Internal Medicine.