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February 16, 2020

Physician Orders for Life-Sustaining Treatment and Limiting Overtreatment at the End of Life

Author Affiliations
  • 1Center for Bioethics, Department of Anesthesiology, Critical Care, and Pain Medicine, Boston Children’s Hospital, Harvard Medical School, Boston, Massachusetts
  • 2Clinical Epidemiology Center, Veterans Affairs Connecticut Healthcare System, West Haven
  • 3Department of Internal Medicine, Yale School of Medicine, New Haven, Connecticut
JAMA. 2020;323(10):934-935. doi:10.1001/jama.2019.22522

In this issue of JAMA, Lee and colleagues1 examine the association between Physician Orders for Life-Sustaining Treatment (POLST), which involve portable medical orders that document treatment limitations for out-of-hospital emergency care and for limiting overtreatment at the end of life. The authors studied adults with chronic life-limiting illnesses who were hospitalized within the last 6 months of life and who had completed a POLST before their last inpatient admission. Among 1818 patients enrolled, 656 (36%) had POLST orders for “full treatment” and 1162 had orders for either “limited additional interventions” (761 [42%]) or “comfort measures only” (401 [22%]). Among the combined latter 2 groups, 472 (41%) were admitted to the intensive care unit (ICU), 436 (38%) received POLST-discordant intensive care, and 204 (18%) received POLST-discordant life-sustaining treatments, defined as mechanical ventilation, vasoactive infusions, new renal replacement therapy, or cardiopulmonary resuscitation. Patients with cancer or dementia were less likely to receive POLST-discordant intensive care, whereas patients hospitalized for traumatic injuries were more likely to receive POLST-discordant intensive care. These results are sobering.

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