Emergency Medicine Provider Comfort with Physician Orders for Life-Sustaining Treatment (POLST) Advanced Directive

Abstract

Introduction: The Physician Orders for Life-Sustaining Treatment (POLST) form has been shown to lead to more goal-concordant care for these patients by providing detailed instructions regarding end-of-life interventions, made by the patient and/or medical decision maker. The aim of this study was to determine the level of awareness and understanding of the POLST form amongst providers at two ACGME-accredited emergency medicine residency programs. Methods: In this needs assessment study, we assessed awareness by sending a 13-item survey to all residents, faculty, and advanced practice providers in the two EDs in the United States. The content of the survey was developed by the study team using a modified Delphi process with content validity evaluated by a panel of emergency medicine and palliative care experts. We evaluated the association between the level of comfort and knowledge using the form and the level of training using the bivariate analysis. Results: Of the 205 questionnaires distributed, we received 63 responses (31%). Only 44% of responders reported using a POLST in the past year, and 40% did not feel comfortable interpreting and applying a POLST. Seventy percent of responders do not know where to locate this form. Furthermore, trainees reported a higher degree of familiarity and comfort with POLST forms when compared to staff physicians. Conclusion: A significant minority of ED providers do not know how to properly apply a POLST form. Our data suggests opportunities to educate ED personnel on locating and applying the POLST form.