Assessing evidence for physician orders for life-sustaining treatment programs—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.