1524P - Multicenter feasibility study of physician orders for life-sustaining treatment (POLST) for terminal cancer patients

Abstract

Background: Terminally ill patients can draw up Physician Orders for Life-Sustaining Treatment (POLST) with physicians to decide whether they want to suspend life-prolonging treatment near death. We conducted a multicenter, prospective study to assess the feasilibity of completing the POLST in real practice for cancer patients. Methods: The inclusion criteria were patients with terminal cancer, age ≥19, and able to communicate. The purpose and concept of POLST was introduced first, and POLST was discussed with those whom wanted. Primary endpoint of this study was the completion rate of the POLST form in Korea. Results: From June to December 2017, 336 patients were enrolled from seven hospitals. The median age was 66 (20-97) years, 177 (52.7%) were male, and 203 (60.4%) showed ECOG 3/4. Hepato-pancreato-biliary cancer (26.2%) was the most common, followed by lung (23.2%) and gastrointestinal (19.9%) origins. The mean expected survival duration was 10.6±7.3 months. At enrollment, 41.2% received hospice care, 29.6% stopped anti-cancer treatment, but 14.0% were in the middle of chemotherapy. The POLST were introduced in 203 patients (60.4%), and 105 patients (31.2%) completed the documentation of POLST. Barriers to introducing POLST were as follows; refusal from family members (29.8%); patients’ denial or unawareness of prognosis (13.4%); lack of rapport with patients (13.3%); uncertainty of prognosis or timing (12.6%); guilty feelings (7.5%); and inadequate time/place (7.2%). Patients refused to sign the POLST due to lack of understanding (32.3%), emotional discomfort (32.3%), difficulty in making decision by themselves (29.8%), and denial of prognosis (5.7%). Conclusions: Only one-third of patients completed the POLST, and various barriers were found among physicians, patients and families. Legal entity responsible for the study: The authors. Funding: This study was supported by grants from the Korean Cancer Study Group. Disclosure: All authors have declared no conflicts of interest.