The Indiana POST Form: Do You Know What You’re Signing?

Abstract

Background: The Indiana Physician Orders for Scope of Treatment (POST) form is utilized as a baseline to develop Advanced Care Directives (ACDs) for many hoosiers. Designed for those with advanced/terminal disease to plan their end-of-life care, it is often the starting point when developing ACDs in general in Indiana. The form requires a physician signature to be recognized; this is no guarantee that all patients filling it out are provided with the same depth and clarity. With such heavy implications, it should be formatted to be digestible by the general populace.

Methods: Patients in the waiting room of a primary care office were recruited through convenience sampling completed three iterations of the POST form in sequence with each having more information than the last. Participants rated how confident they were based on the information they were provided on a seven-point Likert scale to measure the impact of each change throughout the survey.

Results: Measuring the impact of each additional change using paired t-tests, we found that compared to the base POST form, both increased participant confidence (p<0.001). Intriguingly, the added risks and considerations for the third time through the form were not significant, likely due to added variables and potential negatives making participants second guess. Addition of these adverse effects could lead to confusion and outline the role of the physician in the discussion.

Conclusions and Potential Impact: While the form is streamlined for sake of time, adding only the plain-language summary was enough to significantly increase confidence. With further exploration, the Indiana POST form can be improved to allow for more patient autonomy during the decision-making process. By empowering patients to make end-of-life care decisions more in line with their goals, physicians can foster better relationships with patients and be certain that they are acting in their best interests.