Gievers Ladawna, Khaki Sheevaun, Dotson Abby, Chen Zunqiu, Macauley Robert C, Tolle Susan
Department of Pediatrics, Oregon Health and Science University, Portland, OR, USA.
Oregon POLST Registry, Department of Emergency Medicine, Portland, OR, USA.
Am J Hosp Palliat Care. 2022 Jun;39(6):678-686. doi: 10.1177/10499091211041566. Epub 2021 Sep 26.
End of life (EOL) care planning is important for aging adults given the growing prevalence of chronic medical conditions in the US. The Portable Orders for Life Sustaining Treatment (POLST) program promotes communication between clinicians and patients with advanced illness about EOL treatment preferences. Despite growing resources for EOL care, utilization remains unequal based on social determinants of health (SDOH), including race, language, urbanization, and education. We evaluated the relationship between POLST form selections and completion rates and SDOH.
Oregon POLST Registry and American Community Survey data from 2013 to 2017 were analyzed retrospectively. POLST form completion rates and selections, and various SDOH, including age, income, insurance status, urbanization, etc. were recorded. Data were merged based on ZIP codes and analyzed using χ or Wilcoxon-Mann-Whitney tests. Logistic regression was performed.
127,588 POLST forms from 319 ZIP codes were included. POLST form completion rates were highest among urban ZIP codes, and urban registrants more often selected CPR and full treatment. ZIP codes with higher incomes tended to select CPR. ZIP codes with higher rates of private insurance completed POLST forms, and selected CPR and full treatment more frequently. ZIP codes with higher rates of Bachelor's degrees (or higher) completed POLST forms and selected full treatment more frequently.
Various SDOH-specifically, urbanization, insurance status, income level and educational level achieved-may influence POLST form completion rates and selections. The expanding socioeconomic diversity and growth of urban communities, highlight the need for broader access to EOL planning and POLST.
鉴于美国慢性疾病的患病率不断上升，临终关怀规划对老年人来说非常重要。便携式维持生命治疗医嘱（POLST）计划促进了临床医生与晚期疾病患者之间就临终治疗偏好进行沟通。尽管用于临终关怀的资源不断增加，但基于健康的社会决定因素（SDOH），包括种族、语言、城市化和教育程度，其利用率仍然不平等。我们评估了POLST表格选择和完成率与SDOH之间的关系。
对2013年至2017年俄勒冈州POLST登记处和美国社区调查数据进行回顾性分析。记录了POLST表格的完成率和选择情况，以及各种SDOH，包括年龄、收入、保险状况、城市化程度等。数据根据邮政编码进行合并，并使用χ检验或Wilcoxon-Mann-Whitney检验进行分析。进行了逻辑回归分析。
纳入了来自319个邮政编码地区的127,588份POLST表格。城市邮政编码地区的POLST表格完成率最高，城市登记者更常选择心肺复苏（CPR）和全面治疗。收入较高的邮政编码地区倾向于选择CPR。私人保险率较高的邮政编码地区完成了POLST表格，并且更频繁地选择CPR和全面治疗。拥有学士学位（或更高）比例较高的邮政编码地区完成了POLST表格，并且更频繁地选择全面治疗。
各种特定的SDOH，特别是城市化、保险状况、收入水平和所达到的教育水平，可能会影响POLST表格的完成率和选择情况。社会经济多样性的扩大和城市社区的增长，凸显了更广泛地获得临终规划和POLST的必要性。
