The Medical Orders for Scope of Treatment (MOST) form completion: A retrospective study




Mallidou, Anastasia
Tschanz, Coby
Antifeau, Elisabeth
Lee, Kyoung Young
Mtambo, Jenipher Kayuni
Heckl, Holly

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BMC Health Services Research


Background: Advance care planning (ACP) involves discussions about patient and families’ wishes and preferences for future healthcare respecting autonomy, improving quality of care, and reducing overtreatment. The Medical Orders for Scope of Treatment (MOST) form records person preferred level and types of treatment and intervention. Purpose: To examine the MOST form use in inpatient units within a British Columbia (Canada) hospital, estimate and compare its completion rate, and inform health policies for continuous, quality and individualized patient care. Methods: About 5,000 patients admitted to the participating tertiary acute care hospital during October 2020. Data from 780 eligible participants in medical, surgical, or psychiatry unit were analyzed with descriptive statistics, the chi-square test for group comparisons, and logistic regression to assess predictors of the MOST form completion. Results: Participants’ (54% men) age ranged from 20–97 years (mean = 59.53, SD = 19.54). Mainly physicians (99.1%) completed the MOST form for about 60% of them. A statistically significant difference of MOST completion found among the units [Pearson χ2 (df=2, n=780) = 79.53, p < .001, φ = .319]. Multivariate logistic regression analysis demonstrated that age (OR = 1.05, 95% CI 1.04 to 1.06) and unit admission (OR = .60, 95% CI 0.36 to 0.99 in psychiatry; and OR = .21, 95% CI 0.14 to 0.31 in surgery) were independently associated with the MOST form completion. Conclusion: Our findings demonstrate a need for consistent and broad completion of the MOST form across all jurisdictions using, desirably, advanced electronic systems. Healthcare providers need to raise awareness of the MOST completion benefits and be prepared to discuss topics relevant to end-of-life. Further research is required on the MOST form completion.



Advance care planning, Medical Orders for Scope of Treatment (MOST) form, Hospital, Nurse practitioner, Retrospective study, MOST form completion, Health system quality and safety


Mallidou, A. A., Tschanz, C., Antifeau, E., Lee, K. Y., Mtambo, J. K., & Heckl, H. (2022). “The Medical Orders for Scope of Treatment (MOST) form completion: A retrospective study.” BMC Health Services Research, 22(1186).