Assessing Evidence for Physician Orders for Life-Sustaining Treatment Programs

• Autores: Susan W. Tolle, Alvin H. Moss, Susan E. Hickman, Kendra A. Moore, Emily B. Rubin, Scott D. Halpern
• Localización: JAMA: the journal of the American Medical Association, ISSN 0098-7484, Vol. 315, Nº. 22, 2016, págs. 2471-2472
• Idioma: inglés
• Títulos paralelos:
  • Assessing Evidence for Physician Orders for Life-Sustaining Treatment Programs—Reply
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• Resumen
  • English

    Ms Moore and colleagues1 noted that the US health care system provides many dying patients with unwanted medical interventions. They acknowledged the widespread and increasing use of the Physician Orders for Life-Sustaining Treatment (POLST) program and appealed for greater research about the effectiveness of POLST in supporting informed, patient-centered decision making. We agree but diverge in our views about the strength of existing evidence.

  • English

    Dr Tolle and colleagues contend that the current evidence available regarding POLST justifies nationwide implementation of the program. Although an important start in understanding how POLST is currently being used, all available evidence stems from retrospective observational studies that are prone to confounding. There have been no published studies with suitable control groups, let alone studies using experimental designs capable of truly determining whether POLST completion affects patient outcomes. Additionally, the majority of research on POLST has been performed in Oregon, a state with unique demographic and cultural factors that may limit the generalizability of the findings.