ArticleJournal of the American Geriatrics Society2021
Factors associated with concordance between POLST orders and current treatment preferences.
Article in Journal of the American Geriatrics Society, 2021. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 13 papers, 1 of them a synthesis that pooled it.
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Who cites it
13 citing papers in PubMed, 1 synthesis or guideline pooled it.
- The influence of POLST on treatment intensity at the end of life: A systematic review.Journal of the American Geriatrics Society · 2021Pooled it
- Goals of Care: a framework in evolution.Internal medicine journal · 2026Article
- Does Checklist-Guided Shared Decision Making Have a Sustained Effect on Code Status Decisions Among Medical Inpatients? Long-Term Follow Up of the Randomized CLEAR Checklist Trial.Journal of general internal medicine · 2026Article
- State POLST Program Maturity Status and Dying in the Nursing Home or Hospice in the United States: An Event Time Study.Journal of the American Medical Directors Association · 2026Article
- Obligated To Say "Yes": The How and Why Behind Transfer Decisions in Moribund Patients.The western journal of emergency medicine · 2026Article
- Factors influencing self-decision in withholding or withdrawal of life-sustaining treatments among older patients admitted to general hospital: A retrospective case-control study.Journal of Korean gerontological nursing · 2025Article
- Using the Recommended Summary Plan for Emergency Care and Treatment (ReSPECT) in a community setting: does it facilitate best interests decision-making?Journal of medical ethics · 2025Article
- Life-sustaining treatment decisions and family evaluations of end-of-life care for Veteran decedents in Department of Veterans Affairs nursing homes.Journal of the American Geriatrics Society · 2024Article
- An Integrative Review of the State of POLST Science: What Do We Know and Where Do We Go?Journal of the American Medical Directors Association · 2024Review
- Reasons for Discordance Between Life-Sustaining Treatment Preferences and Medical Orders in Nursing Facilities Without POLST.The American journal of hospice & palliative care · 2023Article
- Care preferences in physician orders for life sustaining treatment in California nursing homes.Journal of the American Geriatrics Society · 2022Article
- Neuroethics across the Disorders of Consciousness Care Continuum.Seminars in neurology · 2022Review
- Palliative, palliative or palliative?Critical care (London, England) · 2021Article
Corrections and comments
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Authors and funding
9 authors.
Funding
Abstract
backgroundPOLST is widely used to document the treatment preferences of nursing facility residents as orders, but it is unknown how well previously completed POLST orders reflect current preferences (concordance) and what factors are associated with concordance.
objectivesTo describe POLST preference concordance and identify factors associated with concordance.
designChart reviews to document existing POLST orders and interviews to elicit current treatment preferences.
settingPOLST-using nursing facilities (n = 29) in Indiana.
participantsNursing facility residents (n = 123) and surrogates of residents without decisional capacity (n = 152). MEASUREMENTS: Concordance was determined by comparing existing POLST orders for resuscitation, medical interventions, and artificial nutrition with current treatment preferences. Comfort-focused POLSTs contained orders for do not resuscitate, comfort measures, and no artificial nutrition.
resultsOverall, 55.7% (123/221) of residents and 44.7% (152/340) of surrogates participated (total n = 275). POLST concordance was 44%, but concordance was higher for comfort-focused POLSTs (68%) than for non-comfort-focused POLSTs (27%) (p < 0.001). In the unadjusted analysis, increasing resident age (OR 1.04, 95% CI 1.01-1.07, p < 0.01), better cognitive functioning (OR 1.07, 95% CI 1.02-1.13, p < 0.01), surrogate as the decision-maker (OR 2.87, OR 1.73-4.75, p < 0.001), and comfort-focused POLSTs (OR 6.01, 95% CI 3.29-11.00, p < 0.01) were associated with concordance. In the adjusted multivariable model, only having an existing comfort-focused POLST was associated with higher odds of POLST concordance (OR 5.28, 95% CI 2.59-10.73, p < 0.01).
conclusionsLess than half of all POLST forms were concordant with current preferences, but POLST was over five times as likely to be concordant when orders reflected preferences for comfort-focused care. Findings suggest a clear need to improve the quality of POLST use in nursing facilities and focus its use among residents with stable, comfort-focused preferences.
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