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The Oncology Specialist's Role in POLST Form Completion
Austin J Lammers1, Dana M Zive2, Susan W Tolle3
11 Division of Hematology and Oncology, Department of Medicine, Knight Cancer Institute, Oregon Health & Science University, Portland, OR, USA.
The American Journal of Hospice & Palliative Care
|April 18, 2017
Summary
Oncology specialists are not frequently signing Physician Orders for Life-Sustaining Treatment (POLST) forms for cancer patients. Integrating POLST completion into end-of-life care discussions is recommended for these specialists.
Area of Science:
- Oncology
- Palliative Care
- Medical Ethics
Background:
- Advance care planning is crucial for cancer patients, yet physician involvement in documenting these discussions is unclear.
- Physician Orders for Life-Sustaining Treatment (POLST) forms document patient preferences for end-of-life care.
- Understanding who signs POLST forms for cancer decedents is essential for improving care.
Purpose of the Study:
- To determine the specialties of physicians signing POLST forms for patients who died of cancer.
- To assess the extent of oncology specialist participation in POLST completion.
Main Methods:
- Retrospective cohort study of cancer deaths in Oregon (2010-2011).
- Matching death certificates to the Oregon POLST Registry.
- Determining signing physician specialty via the Oregon Medical Board database.
Main Results:
- 41.0% of 14,979 cancer decedents had a POLST form.
- Primary care physicians signed 53.7% of POLST forms, while oncology specialists signed only 14.9%.
- Over 50% of oncology specialists did not sign any POLST forms.
Conclusions:
- Oncology specialists are not the primary signers of POLST forms for their cancer patients.
- Despite their central role in end-of-life care, POLST completion is low among oncologists.
- Oncology specialists should integrate POLST discussions into goals of care conversations.