Nursing home patients are more likely to receive the treatment they want and less likely to have unwanted hospitalizations and medical interventions under a program using medical forms signed by a physician that detail the patients' decisions about end-of-life care, according to anew study.
Researchers examined the impact of a program where patients fill out the medical forms that record whether they want to receive CPR, hospitalization, and treatments like antibiotics, feeding tubes, and other medical interventions. Doctors review and sign the form and it is added to the patient's medical file. The program -- Physicians Orders for Life-Sustaining Treatment (POLST) -- started because of concerns that traditional patient-generated orders and advance directives were often too vague or did not offer enough details to be helpful in a clinical setting.
"It is really unusual to find something that has an effect on the kind of treatments people receive and ensure that they are consistent with what they want. It seems like it should be easy to do and it's actually really, really hard," said Susan Hickman, of Indiana University, who is the lead author of the study.
The study found that people with POLST forms who said they wished to receive care primarily for pain relief were 59 percent less likely to receive unwanted treatments than those with only a "Do Not Resuscitate" order. POLST participants who requested fewer medical interventions still received pain management treatments at similar levels to other patients, while those who asked for full treatment on their POLST forms were just as likely to receive it as other patients. The program also allows patients who do not want extraordinary resuscitation measures to detail other treatments that they do want.
