Factors associated with implementation of the POLST paradigm: results from a survey of Florida physicians.

Abstract

Objectives: To investigate physicians' awareness and attitudes regarding the Physician Orders for Life-Sustaining Treatment (POLST) concept and to identify barriers and opportunities for its expansion.

Design: Cross-sectional questionnaire, using electronic survey instrument.

Setting: Community.

Patients: 212 physicians from three Florida medical associations and the Florida State University College of Medicine clinical faculty responded to the survey. Of those, 67.9% were familiar with the concept of POLST.

Measurements and main results: Data were collected using a web-based survey, completed in June-July 2012, consisting of qualitative and quantitative questions. Most (95.8%) agreed or strongly agreed that it was a physician's responsibility to discuss end-of-life care and treatment options with patients. Satisfaction with current advanced directives was highly variable. However, a consensus about potential benefits of POLST exists, including assisting the discussion of end-of-life care, decreasing unwanted treatment, and lowering costs. More than 70% of respondents reported they would be more likely to use the POLST form if provided civil and criminal immunity; however, data analysis rendered the apparent association statistically insignificant. Qualitative data were also collected in the form of respondents' recommendations and additional comments.

Conclusions: Physicians vary in their knowledge and opinions regarding the POLST paradigm. Broad opportunities may exist to improve physician knowledge and attitudes toward POLST. Dissemination of educational materials to physicians involved in the end-of-life planning process may increase physician support and use of POLST.