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A4877 - POLST Utilization Among Veterans with Advanced-Stage Lung Cancer
Author Block: S. Nugnet1, S. Golden1, L. Ganzini1, C. G. Slatore1, D. Zive2, D. R. Sullivan2; 1VA Portland Healthcare System, Portland, OR, United States, 2Oregon Health and Science University, Portland, OR, United States.
Introduction: The Oregon Physician Orders for Life-Sustaining Treatment (POLST) Registry aims to improve end-of-life (EOL) care by allowing terminally ill patients to document EOL care preferences for clinicians. Little is known about POSLT registration in the VA Health Care System. The purpose of this project was to compare the characteristics of Veterans with advanced-stage lung cancer who had a registered POLST and to describe their EOL care preferences. Methods: We identified a national cohort of advanced-stage (IIIB and IV) lung cancer patients who were diagnosed between 2007-2013 using the VA Central Cancer Registry (VACCR). We examined a subset of 421 patients who resided in the state of Oregon, which maintains the oldest POLST program in the U.S. We gathered clinical and sociodemographic variables from the VACCR and VA clinical database, and EOL preferences from the Oregon POLST Registry. We compared characteristics among Veterans who completed POLST (n=78) and those who did not (n=343) using bivariate analyses. Results: Among Veterans in Oregon diagnosed with advanced-stage lung cancer, 78 had a registered POLST. The majority of the Oregon cohort was male (98%) with a mean age of 68 (SD±9). Those with a registered POLST were more likely to have a higher income ($51,616 vs. $48,428), lower functional comorbidity index (61% vs. 42%), longer time between diagnosis and death (219 days vs. 123 days), and were less likely to die in a VA facility (70% vs. 90%). Median time between cancer diagnosis and POLST completion was 17.5 weeks and median time between POLST completion and death was 7.0 weeks. Regarding EOL care preferences, 62 (79%) indicated “Do not attempt or resuscitate” for CPR preference, 56 (72%) indicated “Comfort measures only” for medical intervention preference; and 56 (72%) indicated “No artificial nutrition by tube” for nutrition preference. Conclusion: In a state with a well-established POLST program, there is low submission to the POLST Registry among advanced-stage lung cancer patients who receive care in the VA. Veterans who have a registered POLST have higher functional status, a longer time between diagnosis and death, and were less likely to die in a VA care setting. Low submission rates within the VA may be related to government rules that limit data transfer to outside organizations or the use of other surrogate EOL documents such as advance directives. Future research should examine barriers to POLST registration among Veterans with advanced-stage lung cancer.