POLST: Plans Improve End of Life Care

Patients often have strong opinions about what kind of end-of-life care they want to receive. But all too often, doctors are left in the dark.

In a medical crisis, healthcare professionals are committed to doing everything they can to help a patient continue living. The majority of elderly people, however, would actually prefer otherwise. In a survey of Medicare patients, 84 percent said they don’t want life-prolonging drugs that would lower their quality of life, and 77 percent said they would opt against a ventilator even if it could extend their life by a month. More than eight in 10 would rather spend their final days at home than in a hospital or nursing home.

The best way to guarantee you’ll receive the end-of-life care you want is to enact Physician Orders for Life Sustaining Treatment (POLST). Developed to improve the quality of patient care and reduce medical errors, a POLST is a form you fill out with your doctor that turns your preferences into medical orders that all healthcare professionals must obey. It’s generally reserved for patients who are seriously ill or frail, whose current health status indicates the need for standing medical orders.

By working with a primary care practitioner, Portland patients can ensure their wishes will be followed. Creating a POLST offers the following benefits:

It follows you everywhere. The POLST is designed to follow you into any setting—from hospital to home to long-term care facility. “There used to be no such thing as a medical order that follows you home. That’s where the POLST comes into play. It specifically tells medical providers what to do or not do,” says Dr. Justin Sanders, an attending physician in palliative care at the Dana-Farber Cancer Institute.

It bolsters your advance directive. Although a POLST doesn’t replace an advance healthcare directive (AHCD), it can fill in some of the gaps. During a crisis, for example, an advance directive isn’t always immediately accessible. In fact, one study found that as many as 76 percent of physicians whose patients had an advance directive didn’t even know it existed. A POLST can help prevent confusion about a patient’s wishes when:

• The advance directive isn’t accessible.
• Wishes aren’t clearly defined in the AHCD.
• The AHCD is not a physician order.

It’s a medical order. A POLST functions much like a do-not-resuscitate order—only it’s much more comprehensive. It turns your healthcare preferences into an edict that all doctors, paramedics and medical staff must follow. Its instructions can include treatments beyond CPR, such as:

• Pain medication
• Antibiotics
• Nutrition

It facilitates important conversations. Every POLST starts with a conversation between the patient, their family members and a primary care practitioner. Portland patients who opt for this process will benefit from shared decision-making with a healthcare professional about what type of end-of-life care they want to receive.

“In it the patient discusses his or her values, beliefs, and goals for care, and the health care professional presents the patient’s diagnosis, prognosis, and treatment alternatives, including the benefits and burdens of life-sustaining treatment,” says the National POLST Paradigm Task Force. “Together they reach an informed decision about desired treatment, based on the person’s values, beliefs and goals for care.”

To learn more about how a POLST works, talk to your primary care practitioner. Portland patients who are frail or seriously ill can find considerable peace of mind knowing their wishes will be followed.