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UB study: Orders for wishes about life-sustaining treatment often unclear

How do you honor patients’ wishes for treatment at the end of life when they can no longer speak for themselves?

In recent years, a growing number of individuals have turned to the Physicians’ Orders for Life-Sustaining Treatments, or POLST. The POLST is a form a doctor fills out, after consultation with a patient, creating orders to be honored in a medical crisis.

However, a new study from the University at Buffalo Jacobs School of Medicine and Biomedical indicates the information the forms contain is often ambiguous, increasing the chance patients will receive the aggressive treatment they didn’t want.

“In emergency medicine, we are trained to do everything we can to prolong life,” Dr. Brian Clemency, associate professor in the UB Department of Emergency Medicine and first author on the paper, said in a statement.

“The goal of this paper is to help us as emergency medicine physicians honor our patients’ wishes as much as possible,” said Clemency, also a physician with UBMD Emergency Medicine.

The study – “Decisions by Default: Incomplete and Contradictory POLST in Emergency Care” – appeared online in the Journal of the American Medical Directors Association.

The study was conducted in the Erie County Medical Center emergency room, where 100 forms – in New York State, they are called Medical Orders for Life-Sustaining Treatment – were collected from patients. The forms cover such issues as whether patients requested cardiopulmonary resuscitation, do-not-resuscitate orders, intubation, hospitalization, intravenous fluids, feeding tubes and antibiotics. Of the 100 forms collected, 69 percent were incomplete, with at least one section left blank.

“We want to do what the patient wants, but if you don’t tell us what you want, we’re forced to assume you want ‘everything’ done,” Clemency said.

Deborah P. Waldrop, professor in the UB School of Social Work and senior author of the study, said the results suggest that primary care doctors may need more training to help them guide people with serious illnesses to communicate clearly wishes about end-of-life care.

“This research shows that to be effective in reflecting patients’ wishes, these forms need to be filled out completely and without contradictory orders after an informed conversation between a primary care provider and the patient,” she said.


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