POLST: Honoring Patients’ Values and Preferences

 

 

People who develop life-limiting medical conditions have long been encouraged to complete advance directives such as living wills and designation of health care surrogate forms. Such documents are intended to provide some degree of assurance that end-of-life care wishes are honored.  All too often, though, these tools fail to achieve that goal.  That’s why “Physician Order for Life Sustaining Treatment” or POLST was created.

POLST Creation

POLSTUnfortunately, sometimes living wills and health care surrogate designations do not work. This may be because the completed documents are not available or were never completed. Some advance directives may be vague and open to various interpretations.  In some instances, even properly completed documents are not honored.

In previous generations, life expectancy was shorter and options for care, more limited. Today, our patients are living longer with increased frailty.  At the same time, the options for care continue to grow.  We need a better approach to assure that patients’ preferences are honored.

In the 1990s, the medical ethics community in Oregon created a task force to address this issue. As a result, a new tool for honoring patients’ wishes was developed. We know this as “Physician Orders for Life Sustaining Treatment” or POLST.  Because we are committed to honoring our patients’ preferences for end-of-life care, Chapters Health System is now offering this type of advance directive to our hospice patients who might benefit.

How Does POLST Work?

POLSTPOLST is a physician medical order form representing a patient’s medical care preferences. The process starts with advance care planning conversations between patients, their families and a trained healthcare professional such as a physician, nurse practitioner, nurse, social worker or chaplain. The discussion addresses:

  • specific disease
  • treatment options
  • benefits and alternatives to various treatments
  • what to expect as the disease progresses
  • goals of care and
  • patient values

Next, a conversation focusing on treatment preferences can take place.

Other patient wishes are discussed including:

  • cardiopulmonary resuscitation (CPR)
  • relocation to another level of care such as a hospital
  • use of mechanical ventilation
  • administration of antibiotics and IV fluids and
  • use of artificial nutrition (tube feedings)

The POLST form is completed and signed by the patient and the physician, making it an actionable medical order that will be honored within the Chapters Health and its affiliates—Good Shepherd Hospice, HPH Hospice  and LifePath Hospice. The patient’s wishes and preferences are translated into a medical order.

Changing One’s Mind

Over time, circumstances change for all of us. That is especially true for those who are affected by serious illness or frailty.  A document that may have accurately expressed a patient’s wishes for care may, therefore, need to be reconsidered.  For this reason, it is recommended that the POLST document be reviewed any time there is a change in the patient’s health status or level of care.  If care preferences have changed, this document can be changed or revoked as required.

Although the medical orders are only necessarily valid within the hospice, the form serves as an advisory document to community partners and shares the end-of-life choices that Chapters Health patients have made.

Patients who are no longer able to communicate their own wishes may still benefit from having a completed POLST. Under those circumstances, a healthcare professional can complete this form based on the legal representative’s understanding of the patient’s wishes.  The decision maker may then sign the form on behalf of the patient.

This tool to help honor patients’ wishes has now been adopted in many states and healthcare systems, and the list continues to grow. Although no advance directive is perfect, POLST appears to be a large step forward.  We are pleased to be able to provide assurance to our patients that their preferences for care will be honored.

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At Chapters Health System, every day is devoted to educating our patients and keeping them in the place they call home. We are dedicated to ensuring that patients, young and old alike, and their families are able to make educated decisions about important healthcare matters. For more information, please call our helpful Chapters Health team at 1.866.204.8611 or send an email to info@chaptershealth.org. 

Stewart W. Stein, MD

Associate Vice President of Medical Services, Chapters Health System

As the associate vice president of medical services at Chapters Health System, Stewart W. Stein, MD, bring more than three decades of experience as a physician. His extensive background in end-of-life care and a commitment to the delivery of exceptional hospice services are of great benefit to the patients and families. Dr. Stein joined the organization in January 2011.

He previously served as chief medical officer and medical director at Nathan Adelson Hospice in Las Vegas, Nevada. Dr. Stein also provided geriatric, rehabilitative and hospice care for patients in home settings and skilled-nursing facilities as a staff physician with the Kaiser Permanente Department of Continuing Care in San Diego, California.

Dr. Stein is board certified by the American Board of Hospice and Palliative Medicine and was a scholar in residence at the Center for Palliative Studies with San Diego Hospice.

Dr. Stein is a Florida native who was born in Jacksonville and attended the University of Florida, where he earned his Bachelor of Science and medical degrees. He completed his medical internship and residency programs at the University of California at San Diego’s University Hospital.