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Comment & Response |

Assessing Evidence for Physician Orders for Life-Sustaining Treatment Programs—Reply

Kendra A. Moore, BA1; Emily B. Rubin, MD, JD2; Scott D. Halpern, MD, PhD3
[+] Author Affiliations
1Perelman School of Medicine, University of Pennsylvania, Philadelphia
2Division of Pulmonary, Allergy, and Critical Care Medicine, University of Pennsylvania, Philadelphia
3Fostering Improvement in End-of-Life Decision Science Program, University of Pennsylvania, Philadelphia
JAMA. 2016;315(22):2472. doi:10.1001/jama.2016.4039.
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In Reply Dr Tolle and colleagues contend that the current evidence available regarding POLST justifies nationwide implementation of the program. Although an important start in understanding how POLST is currently being used, all available evidence stems from retrospective observational studies that are prone to confounding. There have been no published studies with suitable control groups, let alone studies using experimental designs capable of truly determining whether POLST completion affects patient outcomes. Additionally, the majority of research on POLST has been performed in Oregon, a state with unique demographic and cultural factors that may limit the generalizability of the findings.


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June 14, 2016
Susan W. Tolle, MD; Alvin H. Moss, MD; Susan E. Hickman, PhD
1Center for Ethics in Health Care, Oregon Health & Science University, Portland
2Robert C. Byrd Health Sciences Center, West Virginia University, Morgantown
3School of Nursing, Indiana University, Indianapolis
JAMA. 2016;315(22):2471-2472. doi:10.1001/jama.2016.4024.
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