Factors associated with implementation of the POLST paradigm: results from a survey of Florida physicians.

Objectives: To investigate physicians' awareness and attitudes regarding the Physician Orders for Life-Sustaining Treatment (POLST) concept and to identify barriers and opportunities for its expansion. Design: Cross-sectional questionnaire, using electronic survey instrument. Setting: Community. Patients: 212 physicians from three Florida medical associations and the Florida State University College of Medicine clinical faculty responded to the survey. Of those, 67.9% were familiar with the concept of POLST. Measurements and Main Results: Data were collected using a web-based survey, completed in June-July 2012, consisting of qualitative and quantitative questions. Most (95.8%) agreed or strongly agreed that it was a physician's responsibility to discuss end-of-life care and treatment options with patients. Satisfaction with current advanced directives was highly variable. However, a consensus about potential benefits of POLST exists, including assisting the discussion of end-o f-life care, decreasing unwanted treatment, and lower- ing costs. More than 70% of respondents reported they would be more likely to use the POLST form if provided civil and criminal immunity; however, data analysis rendered the ap- parent association statistically insignificant. Qualitative data were also collected in the form of respondents' recommendations and additional comments. Conclusions: Physicians vary in their knowledge and opinions regarding the POLST paradigm. Broad opportunities may exist to improve physician knowledge and attitudes toward POLST. Dissemination of educational materiah to physicians involved in the end-of-life planning process may increase physician support and use of POLST.Keywords: POLST; advance directives; geriatrics; aging; survey; patient autonomyReceiving quality medical care is the primary concern of individuals diagnosed with advanced life-threatening illnesses. "Quality" end-of-life care includes honoring a patient's preferences regarding life-sustaining treatment. Designed to respect patient autonomy, advance directives enable a patient to specify which treatment he or she wishes to receive or refuse. Despite the prevalence of advance directives, such as living wills or durable powers of attorneys, patient preferences are not con- sistently honored across medical settings (Fagerlin & Schneider, 2004). Traditional advance directives are often ambiguously worded and require interpretation. In an attempt to correct recog- nized shortcomings and improve the planning process for patients with advanced life-threatening illnesses, the Physician Orders for Life-Sustaining Treatment (POLST) paradigm was created (Sabatino & Karp, 2011).The POLST paradigm enhances traditional advance direc- tives by providing a more portable, comprehensive method of communicating a patient's end-of-life preferences. The POLST encourages physician-patient (or surrogate) communication about life-sustaining treatment that enables a patient to make informed decisions regarding end-of-life care. The physician translates these wishes into a clearly documented, actionable medical order that follows a patient across care settings. The POLST form currently being used in several Florida pilot programs (Figure 1) involves a physician's order based on the patient's preferences about cardio- pulmonary resuscitation (CPR) and additional medical interven- tions. A POLST may be used to either limit medical interventions or to clarify a request for indicated treatments (Bomba, Kemp, & Black, 2012). Once signed by the physician and, in some states, the patient or surrogate, the POLST becomes part of a patient's medi- cal record. It is a dynamic document that may be modified based on new information or changes in a patient's condition or prefer- ences. By preserving the original intent of a patient's preferences, the POLST can prevent unwanted or medically ineffective treat- ment and reduce patient and family suffering (POLST for Patients and Family, n. …