POST Forms More Than Advance Directives Associated with Out-of-Hospital Death: Insights from a State Registry

Sandra L. Pedraza, Stacey Culp, Evan C. Falkenstine, Alvin H. Moss

Research output: Contribution to journalArticlepeer-review

20 Scopus citations


Context Patients' end-of-life care outcomes often do not reflect their preferences. Ninety-two percent of West Virginians prefer to die outside the hospital, yet only 58.8% do. Objectives To compare out-of-hospital death (OHD) between those with completed advance directive (AD) and Physician Orders for Scope of Treatment (POST) forms. Methods This was a retrospective cohort study of 2027 West Virginians who submitted AD and/or POST forms to the West Virginia e-Directive Registry and died between October 1, 2010 and December 31, 2013. A multivariable logistic regression model examined the relationship between OHD by form type while adjusting for age and enrollment in hospice. Results Patients who completed an AD were significantly less likely to have an OHD (56.9%) than those who completed a POST form with comfort measures orders or a POST form with limited/full intervention orders (88.4% and 75.9%, respectively, P < 0.001). The odds of OHD were significantly higher for patients with POST forms with comfort measures orders than for those with ADs (OR 4.239, P < 0.001). Conclusion A prospective study is needed to validate that a statewide POST program and registry provide a more effective way than ADs to express, document, and honor patients' preferences for an OHD.

Original languageEnglish (US)
Pages (from-to)240-246
Number of pages7
JournalJournal of Pain and Symptom Management
Issue number2
StatePublished - Feb 1 2016
Externally publishedYes


  • Advance care planning
  • advance directives
  • electronic registry
  • end of life
  • site of death

ASJC Scopus subject areas

  • Nursing(all)
  • Clinical Neurology
  • Anesthesiology and Pain Medicine


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