Physician Orders for Life-Sustaining Treatment in Rural Virginia

Physician Orders for Life-Sustaining Treatment (POLST) arose in 1991 to improve end-of life-care for patients with advanced, chronic, and progressive illnesses whose death is imminent within a year. POLST attempted to address problems inherent in advance directives (e.g., poor completion rates, confusing form language, dismal communication with a surrogate). POLST exists in all U.S. states, although each is unique and uptake is inconsistent, particularly in rural areas. The purpose of this study was to investigate current practices and barriers around POLST in a rural area using an online survey and interviews with practitioners. A total of 101 people responded to the survey, and 20 participated in interviews. Findings included the need for consistent funding, clarification of goals, and greater and varied opportunities for staff training. Also important was establishing strong support for POLST within healthcare entities, physician and community support, identification of champions, and research evaluating processes and patient outcomes.