Portable Medical Orders and End of Life Measures in Acute Myeloid Leukemia and Myelodysplastic Syndromes.

Patients with acute myeloid leukemia (AML) and myelodysplastic syndromes (MDS) experience high rates of hospitalization, intensive care unit (ICU) admissions, and in-hospital deaths at end of life (EOL). Early goals-of-care (GOC) discussions might reduce intensity of care at EOL. Portable Medical Order (POLST) forms, known as Medical Orders for Life Sustaining Treatment (MOLST) forms in New York State, allow patients to translate GOC discussions into specific medical orders that communicate their wishes during a medical emergency. To determine if timing of MOLST form completion might be associated with EOL care in patients with AML and MDS. We conducted a retrospective study of 358 adult patients with AML and MDS treated at a single academic center and/or its affiliated sites and who died over a five year period. One-third of patients completed at least one MOLST form >30 days prior to death. Compared to patients who completed a MOLST form within 30 days of death or never completed a MOLST form, those who completed a MOLST form >30 days prior to death were less likely to receive transfusion [Adjusted Odds ratio (AOR) 0.39, p<0.01], chemotherapy (AOR 0.24, p<0.01), life-sustaining treatments (AOR 0.21, p<0.01), or to be admitted to the ICU (AOR 0.21, p<0.01) at EOL. They were also more likely to utilize hospice (AOR 2.72, p<0.01). Earlier MOLST form completion was associated with lower intensity of care at EOL in patients with MDS and AML.