Emergency Medicine provider comfort with Physician Orders for Life Sustaining Treatment (POLST) Advanced Directive
Abstract
Learning Objective: Our study aimed to determine the level of awareness and understanding of the POLST form amongst Emergency Department (ED) providers in the US and find the specific knowledge gaps so that we can create an educational intervention tailored to those deficiencies and increase use of the form in the ED.
Background: EDs across the US see many patients with advanced disease and in the end of life. The POLST form is becoming a widely used Advanced Directive as it provides detailed instructions regarding end-of-life interventions compared to the vague “Do Not Resuscitate”. Our study aimed to determine the level of awareness and understanding of the POLST form among ED providers and find specific knowledge gaps in order to create an educational intervention tailored to those deficiencies and increase use of the form, thus patient care in the ED.
Methods: Our observational cross-sectional study consisted of sending an anonymous 17-question poll to all residents, attendings, and Advanced Practice Providers (APPs) at two ACGME accredited Emergency Medicine residency programs, The University of Iowa and John Peter Smith Hospital. Four questions were to obtain demographic data and the rest to gauge comfort levels and test the responder’s knowledge of the POLST and related regulations. The poll was created and sent using the online software, Qualtrics, with Likert scale style questions in November 2021 to nearly 150 providers. We are still undergoing further analysis of the data using Statistical Analysis Software (SAS).
Results: Of the 58 respondents, 45% were attendings, 47% residents, and the rest APPs. 53% practiced in Texas, the rest in Iowa. 19% of respondents believe that they have not received any palliative care training to date. 78% were not confident applying the POLST and 72% of respondents did not know where to look in their workplace for it. 91% were not confident applying the form without the family present. 37% of respondents agreed that the POLST supersedes a durable power of attorney.
Conclusion: Our data shows us that there are many ED providers that are unaware of the POLST and do not know how to find, interpret, and apply the form correctly. Next steps are to create an effective educational intervention and resurvey participants to determine our success.