Pedraza Sandra L, Culp Stacey, Knestrick Mark, Falkenstine Evan, Moss Alvin H
West Virginia University; and West Virginia Center for End-of-Life Care, Morgantown, WV.
J Oncol Pract. 2017 Oct;13(10):e881-e888. doi: 10.1200/JOP.2017.022566. Epub 2017 Jul 20.
Many patients with advanced cancer receive aggressive treatment near the end of life. The Physician Orders for Life-Sustaining Treatment (POLST) form is an innovation that converts patient preferences into medical orders. We compared the end-of-life care of patients with advanced cancer who had completed POLST forms with that of patients who had advance directives (ADs).
We studied 2,159 West Virginians with ADs and/or POLST forms in the West Virginia e-Directive Registry who died as a result of cancer between January 2011 and February 2016. Data from the Vital Registration Office (date, site, and cause of death) were merged with those from the registry (form type, completion date, and hospice admission). The primary outcome variables were out-of-hospital death (OHD) and hospice admission.
The percentage of patients with OHD was 85.7% for patients with POLST forms compared with 72.0% for those with ADs ( P < .001). The odds of OHD for patients with POLST forms were 2.33 times those of patients with ADs. The percentage of patients admitted to hospice was 49.9% for those with POLST forms compared with 27.0% for those with ADs ( P < .001). The odds of being admitted to hospice for patients with POLST forms were 2.69 times those of patients with ADs.
Advance care planning with completion of POLST forms compared with ADs in patients with advanced cancer was associated with two quality end-of-life care metrics: OHD and hospice admission. Our study suggests that goals-of-care discussions including POLST form completion may improve end-of-life care for patients with advanced cancer.
许多晚期癌症患者在生命末期接受积极治疗。医生维持生命治疗医嘱（POLST）表格是一项创新举措，可将患者的偏好转化为医疗医嘱。我们比较了已填写POLST表格的晚期癌症患者与有生前预嘱（AD）的患者的临终关怀情况。
我们研究了西弗吉尼亚电子预嘱登记处中2159名有AD和/或POLST表格且于2011年1月至2016年2月期间死于癌症的西弗吉尼亚州居民。生命登记办公室的数据（死亡日期、地点和原因）与登记处的数据（表格类型、填写日期和临终关怀入院情况）进行了合并。主要结局变量为院外死亡（OHD）和临终关怀入院情况。
有POLST表格的患者中OHD的比例为85.7%，而有AD的患者为72.0%（P<.001）。有POLST表格的患者发生OHD的几率是有AD的患者的2.33倍。有POLST表格的患者临终关怀入院率为49.9%，而有AD的患者为27.0%（P<.001）。有POLST表格的患者进入临终关怀的几率是有AD的患者的2.69倍。
与AD相比，晚期癌症患者填写POLST表格进行的预先护理计划与两个高质量的临终关怀指标相关：OHD和临终关怀入院。我们的研究表明，包括填写POLST表格在内的照护目标讨论可能会改善晚期癌症患者的临终关怀。
