@article{e7109cb43d484f8cb54db9540750ceab,
title = "POST Forms More Than Advance Directives Associated with Out-of-Hospital Death: Insights from a State Registry",
abstract = "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.",
keywords = "Advance care planning, POLST, advance directives, electronic registry, end of life, site of death",
author = "Pedraza, {Sandra L.} and Stacey Culp and Falkenstine, {Evan C.} and Moss, {Alvin H.}",
note = "Funding Information: The subjects for this study were all West Virginians who voluntarily submitted or had submitted for them completed ADs and/or POST forms to the West Virginia e-Directive Registry and died between October 1, 2010 and December 31, 2013. The West Virginia e-Directive Registry ( http://www.wvendoflife.org/e-Directive-Registry ) is operated by the West Virginia Center for End-of-Life Care and funded by the West Virginia Department of Health and Human Resources. Patients (or their medical power-of-attorney representative or health care surrogate if the patient lacks decision-making capacity) can initial an opt-in box on an AD or POST form to authorize their form(s) to be sent to the registry and released to treating health care providers. Patients can change all forms submitted to the registry to update them to reflect their current wishes; their older forms are archived and kept in the registry for documentation purposes, but they are not accessible to treating health care providers. The West Virginia e-Directive Registry is accessible 24 hours a day, seven days a week through the West Virginia Health Information Network online portal ( http://www.wvhin.org/default.aspx ). Funding Information: This research was supported in part by the Mei-Ying Huang Research Fund of the West Virginia University Center for Health Ethics and Law . The authors declare no conflicts of interest. Publisher Copyright: {\textcopyright} 2016 American Academy of Hospice and Palliative Medicine.",
year = "2016",
month = feb,
day = "1",
doi = "10.1016/j.jpainsymman.2015.10.003",
language = "English (US)",
volume = "51",
pages = "240--246",
journal = "Journal of Pain and Symptom Management",
issn = "0885-3924",
publisher = "Elsevier Inc.",
number = "2",
}