Cross-Cultural Adaptation of the Physician Orders for Life-Sustaining Treatment Form in Greece; a pilot cross-sectional descriptive study

Abstract

The current legal framework in Greece does not permit withholding medical interventions to allow natural death, leading to a lack of documented advance directives to guide clinical practice. The aim of this pilot descriptive study is to culturally adapt the Physician Orders for Life-Sustaining Treatment (POLST) form, and use it as a framework with which to assess the readiness of Greek residents for discussions on medical care near the end of life. Patients with severely limited prognosis and/or their family members were interviewed by attending physicians who then recorded their wish with regards to Do-Not-Resuscitate (DNR) status on the adapted POLST form, as well as their level of agreement with signing a similar form. Thirty-one patients with an age range of 18 to 109 years old participated. All had severe prognosis due to various end-stage diseases. Sixteen patients (51.6%) wished for DNR status and did not wish for further intervention in case they suffered cardio-respiratory arrest. Presence of an end-stage malignancy was associated with a higher chance of DNR preference (OR: 8.8, 95%CI 1.5-50, p = 0.017) or comfort measures only (OR: 5.6, 95%CI 1.1-30, p = 0.05). This pilot study of patients with severe prognosis hospitalized in a tertiary care center in Greece showed preliminary evidence of high acceptance of natural death and DNR status. POLST forms could be used as a framework for advance care planning through shared decision-making, thus reducing unwarranted treatments and enhancing trust between healthcare professionals and patients at the end of life.