An Integrative Review of the State of POLST Science: What Do We Know and Where Do We Go?

Published in Journal of the American Medical Directors Association. Here is a link to the article.

Regenstrief Institute author: Susan Hickman, PhD.

This integrative review examined research on Physician Orders for Life-Sustaining Treatment (POLST) and its impact on advance care planning (ACP) outcomes. Among 94 studies, POLST use was significantly associated with improved Quality of Care—especially treatment concordance with patient preferences—and positive Action outcomes. However, evidence from nonrandomized studies showed mixed results for healthcare utilization and no significant impact on health status. The review highlights the need for prospective, mixed-methods, and high-quality trials to better evaluate POLST’s effects across diverse patient and health system outcomes.

Authors

Elizabeth E. Umberfield PhD, RN ^ab, Matthew C. Fields BSN, RN ^cd, Rachel Lenko PhD, RN ^e, Teryn P. Morgan BS ^fg, Elissa Schuler Adair PhD ^h, Erik K. Fromme MD ^ij, Hillary D. Lum MD, PhD ^k, Alvin H. Moss MD ^lm, Neil S. Wenger MD, MPH ⁿ, Rebecca L. Sudore MD ^op, Susan E. Hickman PhD ^cdq

Affiliations

^aDivision of Nursing Research, Department of Nursing, Mayo Clinic, Rochester, MN, USA
^bDepartment of Artificial Intelligence and Informatics, Mayo Clinic, Rochester, MN, USA
^cSchool of Nursing, Indiana University, Indianapolis, IN, USA
^dResearch in Palliative and End-of-Life Communication and Training (RESPECT) Signature Center, Indiana University Purdue University Indianapolis, Indianapolis, IN, USA
^eDepartment of Nursing, School of Health, Calvin University, Grand Rapids, MI, USA
^fCenter for Biomedical Informatics, Regenstrief Institute, Inc, Indianapolis, IN, USA
^gDepartment of BioHealth Informatics, School of Informatics and Computing, Indiana University, Indianapolis, IN, USA
^hLines for Life, Portland, OR, USA
ⁱDepartment of Psychosocial Oncology and Palliative Care, Dana-Farber Cancer Institute, Boston, MA, USA
^jAriadne Labs at Brigham and Women’s Hospital and the Harvard T. H. Chan School of Public Health, Boston, Massachusetts, USA
^kDivision of Geriatric Medicine, Department of Medicine, University of Colorado School of Medicine, Aurora, CO, USA
^lCenter for Health Ethics and Law, West Virginia University Health Sciences Center, Morgantown, WV, USA
^mDivisions of Nephrology and Palliative Medicine, School of Medicine, West Virginia University, Morgantown, WV, USA
ⁿDivision of General Internal Medicine and Health Services Research, David Geffen School of Medicine, University of California, Los Angeles, CA, USA
^oDivision of Geriatrics, Department of Medicine, University of California, San Francisco, CA, USA
^pSan Francisco Veterans Affairs Medical Center, San Francisco, CA, USA
^qIndiana University Center for Aging Research, Regenstrief Institute, Inc, Indianapolis, IN, USA