An Integrative Review of the State of POLST Science: What Do We Know and Where Do We Go? (GP106)

Outcomes 1. Describe the current state of POLST research and the characteristics of existing studies including the race and ethnicity of participants, study setting, and state where the research was performed, the available level of evidence, gaps in knowledge, and directions for future research. 2. Describe the associations between POLST and advance care planning outcome domains previously identified by an international Delphi panel including Action, Quality of Care, Health Status, and Healthcare Utilization. Key Message In this integrative review of 94 studies, we found that a majority advance care planning outcomes (61%) were positive in studies comparing POLST with non-POLST using patients. Patients with POLST were more likely to have their treatment preferences documented and followed than patients without POLST. Importance POLST is an advance care planning (ACP) tool for documenting the preferences of patients with serious illness as medical orders. Given its widespread use, it is critical that we understand the evidence about its association with the broad array of key ACP outcome domains. Objective(s) Describe the effects on POLST on ACP outcome domains and identify directions for future research. Scientific Methods Utilized Using established methods,(1) we queried PubMed and CINAHL databases to identify research on POLST conducted between 1996-2022. We abstracted study information and assessed study design quality.(2) Study outcomes were categorized using the international ACP Outcomes Framework: Process, Action, Quality of Care, Health Status, and Healthcare.(3) Results Out of 94 POLST studies identified, 38 (40%) had at least a moderate level of study design quality and 15 of these included POLST vs. non-POLST patient comparison groups. There were significant differences between groups for 40/70 (57%) outcomes. The highest proportion of significant outcomes were in Quality of Care (15/19 or 79%): POLST use was significantly associated with the subdomains of concordance between treatment and documentation (14/18 or 78%) and preferences concordant with documentation (1/1 or 100%). The Action outcome domain had the second highest positive rate among outcome domains; 9 of 12 (75%) action outcomes were statistically significantly different between those who used and did not use POLST. Healthcare Utilization outcomes were the most frequently assessed and approximately half (16/35 or 46%) were statistically significant. Health Status outcomes were not significant (0/4 or 0%) and no Process outcomes were identified. Conclusion(s) A majority of POLST outcomes were positive and use is significantly associated with a range of ACP outcomes in comparison to usual care, albeit in non-randomized studies. Impact Future research on POLST should focus on prospective mixed methods studies and pragmatic trials that assess a broad range of person and health system level outcomes.