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JAMA Features Two FIELDS Publications in its End-of-Life Issue

Source: JAMA, January 19, 2016

In “Comparison of Site of Death, Health Care Utilization, and Hospital Expenditures for Patients Dying With Cancer in 7 Developed Countries”, Scott Halpern et al. studied patients 65 years or older who died with cancer in Belgium, Canada, England, Germany, Norway, the Netherlands, and the United States in 2010.  Findings indicate that end-of-life care in the United States and the Netherlands was less hospital-centric for these patients than it was in the other countries, but that hospital expenditures at end-of-life were higher in the United States, Norway, and Canada than they were in the other countries.  They also found that intensive care unit admissions occurred more than twice as often in the United States as in the other countries.

Kendra Moore, Emmy Rubin, and Scott Halpern express concern about the growing Physician Orders for Life-Sustaining Treatment (POLST) movement in the US in “The Problems With Physician Orders for Life-Sustaining Treatment”.  Their primary concern is that POLST lacks a consistent and substantive evidence base. The evidence that is available suggests that POLST is effective for emergency interventions but not newer clinical interventions. Other concerns include the potential  threat to patient-centered decision making when no accommodations are made for the context-dependent way in which many seriously ill patients reach medical decisions and errors in interpretation by healthcare providers. The authors suggest that we should overcome these problems with POLST before advocating for it.