Providing treatment that is discordant with patients’ preferences for end-of-life care can lead to unnecessary or unwanted treatment. This article summarizes the incidence of treatment discordant with their Portable Orders for Life Sustaining Treatment (POLST) and advanced directives (ADs) and tools for use by clinicians and patients and family members to promote concordant care. A previous PSNet WebM&M Spotlight Case discusses the importance of advanced care planning and the consequences of inadequate communication and planning for end-of-life care.

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Prior research found significant confusion among physicians in understanding Physician Orders for Life-Sustaining Treatment (POLST) documents, which can lead to errors. This study found that emergency medical services (EMS) personnel did not exhibit adequate understanding of all POLST or living will documents either. The researchers propose that patient video messaging can increase clarity about treatment, and preserve patient safety and autonomy.

This single-center study found that Do-Not-Resuscitate (DNR) orders and Physician Orders for Life-Sustaining Treatment (POLSTs) created at hospital admission often do not reflect the true wishes of patients and their caregivers. When queried by study staff, 44% of patients expressed wishes for life-sustaining treatment that differed from their designated code status; this resulted in revocation of the DNR order in more than one-third of patients with a discrepancy. A prior study argued that inaccurate documentation of patient's wishes for end-of-life care should be considered a medical error.

This survey of emergency department physicians found that significant confusion in understanding of Physician Orders for Life-Sustaining Treatment (POLST) documents exists. The authors suggest that additional research and training are required to protect patients' decisions. A related study revealed variation in interpretations of POLST orders by prehospital emergency responders. A previous AHRQ WebM&M commentary discusses how confusion in resuscitation status can result in a patient receiving unwanted care.

This case report describes an error in which physicians mistook a patient's living will for a do-not-resuscitate (DNR) order. The authors discuss common misunderstandings about advanced directives and DNR orders as well as how such mix-ups may affect patient care and safety.