POST Forms More Than Advance Directives Associated With Out-of-Hospital Death: Insights From a State Registry
J Pain Symptom Manage. 2016 Feb;51(2):240-6. doi: 10.1016/j.jpainsymman.2015.10.003. Epub 2015 Oct 23.
Sandra L Pedraza 1 , Stacey Culp 2 , Evan C Falkenstine 3 , Alvin H Moss 4
1 Department of Medicine, West Virginia University School of Medicine, Morgantown, West Virginia, USA. Electronic address: sapedraza@hsc.wvu.edu.
2 Department of Statistics, West Virginia University, Morgantown, West Virginia, USA.
3 West Virginia Center for End-of-Life Care, Morgantown, West Virginia, USA.
4 Department of Medicine, West Virginia University School of Medicine, Morgantown, West Virginia, USA. Electronic address: amoss@hsc.wvu.edu.
DOI: 10.1016/j.jpainsymman.2015.10.003
Context: Patients' end-of-life care outcomes often do not reflect their preferences. Ninety-two percent of West Virginians prefer to die outside the hospital, yet only 58.8% do.
Objectives: To compare out-of-hospital death (OHD) between those with completed advance directive (AD) and Physician Orders for Scope of Treatment (POST) forms.
Methods: This was a retrospective cohort study of 2027 West Virginians who submitted AD and/or POST forms to the West Virginia e-Directive Registry and died between October 1, 2010 and December 31, 2013. A multivariable logistic regression model examined the relationship between OHD by form type while adjusting for age and enrollment in hospice.
Results: Patients who completed an AD were significantly less likely to have an OHD (56.9%) than those who completed a POST form with comfort measures orders or a POST form with limited/full intervention orders (88.4% and 75.9%, respectively, P < 0.001). The odds of OHD were significantly higher for patients with POST forms with comfort measures orders than for those with ADs (OR 4.239, P < 0.001).
Conclusion: A prospective study is needed to validate that a statewide POST program and registry provide a more effective way than ADs to express, document, and honor patients' preferences for an OHD.
Keywords: Advance care planning; POLST; advance directives; electronic registry; end of life; site of death.
Copyright © 2016 American Academy of Hospice and Palliative Medicine. Published by Elsevier Inc. All rights reserved.
Advance Directives / statistics & numerical data*
Age Factors
Hospice Care / statistics & numerical data
Housing / statistics & numerical data
Mortality*
Nursing Homes / statistics & numerical data
Terminal Care / methods
Terminal Care / statistics & numerical data*
West Virginia / epidemiology