The Oncology Specialist's Role in POLST Form Completion

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.