1 Center for Policy and Research in Emergency Medicine, Oregon Health & Science University, Portland, Oregon.
2 Center for Ethics in Health Care, Oregon Health & Science University, Portland, Oregon.
J Palliat Med. 2019 May;22(5):500-507. doi: 10.1089/jpm.2018.0446. Epub 2018 Nov 21.
The Physician Orders for Life-Sustaining Treatment (POLST) began in Oregon in 1993 and has since spread nationally and internationally. Describe and compare demographics and POLST orders in two decedent cohorts: deaths in 2010-2011 (Cohort 1) and in 2015-2016 (Cohort 2). Descriptive retrospective study. Oregon decedents with an active form in the Oregon POLST Registry. Oregon death records were matched with POLST orders. Descriptive analysis and logistic regression models assess differences between the cohorts. The proportion of Oregon decedents with a registered POLST increased by 46.6% from 30.9% (17,902/58,000) in Cohort 1 to 45.3% (29,694/65,458) in Cohort 2. The largest increase (83.3%) was seen in decedents 95 years or older with a corresponding 78.7% increase in those with Alzheimer's disease and dementia, while the interval between POLST form completion and death in these decedents increased from a median of 9-52 weeks. Although orders for do not resuscitate and other orders to limit treatment remained the most prevalent in both cohorts, logistic regression models confirm a nearly twofold increase in odds for cardiopulmonary resuscitation and full treatment orders in Cohort 2 when controlling for age, sex, race, education, and cause of death. Compared with Cohort 1, Cohort 2 reflected several trends: a 46.6% increase in POLST Registry utilization most marked in the oldest old, substantial increases in time from POLST completion to death, and disproportionate increases in orders for more aggressive life-sustaining treatment. Based on these findings, we recommend testing new criteria for POLST completion in frail elders.
《生命维持治疗医师指令》（POLST）于 1993 年在俄勒冈州开始实施，此后已在全国乃至国际范围内推广。本研究旨在描述和比较两个死亡队列的人口统计学特征和 POLST 指令：2010-2011 年（队列 1）和 2015-2016 年（队列 2）的死亡。这是一项描述性的回顾性研究。研究对象为在俄勒冈州 POLST 注册中心有有效表格的俄勒冈州死者。将俄勒冈州的死亡记录与 POLST 指令相匹配。描述性分析和逻辑回归模型评估了两个队列之间的差异。从队列 1的 30.9%（17902/58000）到队列 2的 45.3%（29694/65458），俄勒冈州死者中注册 POLST 的比例增加了 46.6%。在 95 岁及以上的死者中，增幅最大（83.3%），阿尔茨海默病和痴呆患者的增幅为 78.7%，而这些死者的 POLST 表格填写和死亡之间的时间间隔从中位数 9-52 周增加。尽管在两个队列中，不进行心肺复苏和其他限制治疗的医嘱仍然最为常见，但在控制年龄、性别、种族、教育程度和死因后，逻辑回归模型证实，在队列 2中，心肺复苏和全面治疗医嘱的几率几乎增加了一倍。与队列 1相比，队列 2反映了几个趋势：POLST 登记处利用率增加了 46.6%，在最年长的老年人中最为明显，从 POLST 完成到死亡的时间大幅增加，以及更为激进的生命维持治疗医嘱的不成比例增加。基于这些发现，我们建议在体弱的老年人中测试新的 POLST 完成标准。
