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POLST Registration and Associated Outcomes Among Veterans With Advanced-Stage Lung Cancer.

Shannon M Nugent1,2, Christopher G Slatore1,2, Linda Ganzini1,2

  • 11 Center to Improve Veteran Involvement in Care, VA Portland Healthcare System, Portland, OR, USA.

The American Journal of Hospice & Palliative Care
|February 1, 2019
PubMed
Summary

Veterans with a registered Physicians Orders for Life-Sustaining Treatment (POLST) form were more likely to use hospice care and less likely to die in a VA facility. POLST may improve end-of-life care, but VA submission rates need enhancement.

Keywords:
EOL careadvance care planninghospice enrollmentlocation of deathlung cancerpalliative carephysician orders for life-sustaining treatment

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Area of Science:

  • Gerontology
  • Palliative Care
  • Health Services Research

Background:

  • Physicians Orders for Life-Sustaining Treatment (POLST) facilitates documentation of end-of-life (EOL) care preferences for patients with advanced illnesses.
  • Understanding EOL care patterns among Veterans is crucial for improving healthcare delivery.

Purpose of the Study:

  • To examine the characteristics of Veterans with and without a registered POLST.
  • To assess the association between registered POLST and EOL care outcomes, including hospice enrollment and place of death.

Main Methods:

  • Retrospective cohort study of advanced-stage lung cancer patients diagnosed between 2008-2013 from the VA Central Cancer Registry.
  • Analysis of a subgroup of 346 Oregon residents, comparing those with and without a registered POLST using clinical, sociodemographic, and EOL preference data.

Main Results:

  • Twenty-two percent of the cohort had a registered POLST.
  • Veterans with a POLST had higher income and longer survival post-diagnosis.
  • POLST registrants showed increased hospice enrollment (aOR=2.37) and decreased VA facility deaths (aOR=0.27).

Conclusions:

  • Low POLST Registry submission rates were observed among Veterans receiving VA care.
  • Registered POLST was associated with higher hospice utilization and fewer deaths in VA facilities.
  • POLST has potential to enhance EOL care quality, with opportunities for improved VA implementation and submission.