Study: Some Patients Still Receive Unwanted Care at End of Life

February 28th, 2020

By Jill Drachenberg, Editor, Relias Media

Patients with chronic illness often authorize a Physician Orders for Life-Sustaining Treatment (POLST) describing or limiting the treatments they wish to receive if hospitalized. These include do not resuscitate orders, requests for comfort care only, or wishes for full treatment. But some patients hospitalized near the end of life may be receiving discordant care, according to the authors of a new study.

The authors of the study, published in JAMA, examined 1,800 patients who were hospitalized within six months of their deaths. Twenty-two percent had POLST orders for comfort care only, 42% for limited interventions, and 36% for full treatment. Patients with comfort care or limited intervention orders were far less likely to receive ICU care, although 38% of these patients received POLST-discordant care, defined as mechanical ventilation, CPR, dialysis, and vasopressors. Other findings include:

• Patients admitted with traumatic injuries were the most likely to receive discordant care (45% comfort care orders vs. 51% with limited care orders).
• Patients with dementia were the least likely to receive discordant care.
• Patients with cancer also were significantly less likely to receive care against their wishes.

These study results are “sobering,” according to the authors of an accompanying editorial. Physicians must ensure patients “near the end of life receive only those treatments that are both desired and beneficial,” they wrote.

More patients with chronic illness recognize the importance of completing POLST forms. A study conducted in Oregon revealed a 46.6% increase in POLST registry use between 2010 and 2011 and between 2015 and 2016, as reported in Medical Ethics Advisor. More patients are indicating full treatment measures, and patients with Alzheimer’s disease and Parkinson’s disease are completing the forms earlier in their disease stages.

See Medical Ethics Advisor for more information on POLST and other end-of-life treatment concerns.