Gundersen Lutheran Medical Foundation, La Crosse, Wisconsin 54601, USA.
J Palliat Med. 2012 Jan;15(1):77-85. doi: 10.1089/jpm.2011.0178. Epub 2012 Jan 10.
Determine the use and utility of the Physician Orders for Life-Sustaining Treatment (POLST) program in a community where powers of attorney for health care (POAHCs) are prevalent.
A retrospective review of medical record and death certificate data of 400 adults who died between September 1, 2007, and March 31, 2008, in the La Crosse County, Wisconsin community. Demographic and cause-of-death data were collected from death certificates. Information about POAHC, POLST forms, and medical treatments provided in the last 30 days of life were abstracted from decedents' medical records.
Sixty-seven percent of decedents had a POLST form, whereas 22% had POAHC alone. In comparison with decedents with POAHC alone, decedents with a POLST form were significantly older (83 versus 77 years, p<0.001), more likely to die in a nursing home than in a hospital (p<0.001), and more likely to die from a terminal or chronic illnesses (97%). Decedents with POLST orders for higher levels of medical treatment received more treatment, and in only two cases was there evidence that treatment was discrepant with POLST orders. In 31% of all POLST forms, the person appointed in the POAHC consented to the POLST orders.
POLST can be a highly effective program to ensure that patient preferences are known and honored in all settings. POAHCs are valuable because they identify appropriate surrogates when patients are incapacitated.
在一个普遍存在医疗保健授权书（POAHC）的社区中，确定生命维持治疗医师指令（POLST）计划的使用和效用。
对 2007 年 9 月 1 日至 2008 年 3 月 31 日期间在威斯康星州拉克罗斯县死亡的 400 名成年人的病历和死亡证明数据进行回顾性审查。从死亡证明中收集人口统计学和死因数据。从死者的病历中提取有关 POAHC、POLST 表格和生命最后 30 天提供的医疗治疗的信息。
67%的死者有 POLST 表格，而 22%的死者只有 POAHC。与单独使用 POAHC 的死者相比，使用 POLST 表格的死者年龄明显更大（83 岁与 77 岁，p<0.001），更有可能在养老院而不是医院死亡（p<0.001），更有可能死于终末期或慢性疾病（97%）。接受更高水平医疗治疗的 POLST 医嘱死者接受了更多的治疗，只有两例证据表明治疗与 POLST 医嘱不符。在所有 POLST 表格中，有 31%的表格中，在 POAHC 中指定的人同意 POLST 医嘱。
POLST 可以是一个非常有效的计划，以确保在所有情况下都了解和尊重患者的偏好。POAHC 很有价值，因为它们在患者丧失能力时确定了合适的代理人。
