Department of General Internal Medicine, Seoul National University Bundang Hospital, Seongnam, Korea.
Ann Palliat Med. 2022 Jul;11(7):2319-2326. doi: 10.21037/apm-21-3158. Epub 2022 May 23.
Hospitalists are becoming increasingly involved in end-of-life (EOL) care decision making. They participate in the completion of physician orders for life-sustaining treatment (POLST) for patients who have not yet decided whether to proceed with life-sustaining treatment (LST) at the EOL. However, hospitalists are not physicians who have continuously treated patients in outpatient settings; hence, the continuity of care may be poor. We aimed to analyze the effect of outpatient physician involvement on the POLST completed by hospitalists.
A retrospective cohort study was conducted in patients aged 18 years or older treated by hospitalists who completed POLST at Seoul National University Bundang Hospital from February 2018 to March 2020. The clinical and sociodemographic data were obtained through a medical chart review, and the differences in the characteristics of POLST were analyzed depending on the status of outpatient physician involvement.
A total of 3,533 POLST forms were written, of which 175 (5.22%) were completed by the hospitalists. The proportion of POLSTs completed by hospitalists gradually increased from 2.53% in 2018 to 4.58% in 2019 and 15.9% in 2020. A total of 144 (82.3%) patients had malignancies, while 31 (17.7%) patients had non-cancer illnesses. In 47.4% of the patients, outpatient physicians were involved in completing physician's orders for LST. When the outpatient physicians were involved, more patients signed the POLST form themselves (P=0.02) and chose comfort measures only when asked to determine their preferred LST type (P=0.00).
The completion of POLST by hospitalists is gradually increasing. LST was reduced when the outpatient physicians participated in the completion of POLST. Using measures to increase the involvement of outpatient providers in goal care discussions, the quality and goal concordance of EOL care can be improved.
住院医师越来越多地参与临终（EOL）护理决策。他们为尚未决定是否在 EOL 进行生命支持治疗（LST）的患者完成医生对维持生命治疗的医嘱（POLST）。然而，住院医师不是一直在门诊环境中治疗患者的医生；因此，护理的连续性可能较差。我们旨在分析门诊医生参与对住院医师完成的 POLST 的影响。
对 2018 年 2 月至 2020 年 3 月在首尔国立大学盆唐医院接受住院医师治疗并完成 POLST 的 18 岁及以上患者进行回顾性队列研究。通过病历回顾获取临床和社会人口统计学数据，并根据门诊医生参与情况分析 POLST 特征的差异。
共完成 3533 份 POLST 表格，其中 175 份（5.22%）由住院医师完成。住院医师完成的 POLST 比例从 2018 年的 2.53%逐渐增加到 2019 年的 4.58%和 2020 年的 15.9%。共有 144 名（82.3%）患者患有恶性肿瘤，而 31 名（17.7%）患者患有非癌症疾病。在 47.4%的患者中，门诊医生参与了完成医生对 LST 医嘱的工作。当门诊医生参与时，更多的患者自己签署了 POLST 表格（P=0.02），并且当被要求确定他们首选的 LST 类型时，更多的患者选择仅接受舒适治疗（P=0.00）。
住院医师完成 POLST 的比例逐渐增加。当门诊医生参与 POLST 的完成时，LST 减少了。通过采取措施增加门诊提供者参与目标护理讨论的参与度，可以提高 EOL 护理的质量和目标一致性。
