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

In this issue of JAMA, Lee and colleagues 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 hospit alized for traumatic injuries were more likely to receive POLST-discordant intensive care. These results are sobering.
Source: JAMA - Journal of the American Medical Association - Category: General Medicine Source Type: research

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Source: Giornale Italiano di Dermatologia e Venereologia - Category: Dermatology Tags: G Ital Dermatol Venereol Source Type: research
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Source: Office of Criminal Investigations (OCI) Press Releases - Category: Medical Law Authors: Source Type: news
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Source: Journal of the American College of Surgeons - Category: Surgery Authors: Tags: Urology Source Type: research
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Source: Fight Aging! - Category: Research Authors: Tags: Newsletters Source Type: blogs
Dear Carol: My father is 72 and is in the moderate stages of dementia. Before his dementia diagnosis, he was an active hunter and fisherman. He also has incontinence issues due to prostate cancer, surgery, and treatment. This requires an external urinary attachment system to maintain an active daily life. My mother, as his primary caregiver, works diligently to keep the system and attachments clean and in working order. However, he is at the stage in his dementia journey where he is not able to maintain this attachment on his own. Yet he is defiant when we try to explain that he cannot go on trips with friends because...
Source: Minding Our Elders - Category: Geriatrics Authors: Source Type: blogs
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Source: American Journal of Clinical Oncology - Category: Cancer & Oncology Tags: Original Articles: Genitourinary Source Type: research
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