The POLST (Physician Orders for Life-Sustaining Treatment) Paradigm to Improve End-of-Life Care: Potential State Legal Barriers to Implementation

Abstract

The Physician Orders for Life-Sustaining Treatment (POLST) Paradigm is designed to improve end-of-life care by converting patients' treatment preferences into medical orders that are transferable throughout the health care system. It was initially developed in Oregon, but is now implemented in multiple states with many others considering its use. An observational study was conducted in order to identify potential legal barriers to the implementation of a POLST Paradigm. Information was obtained from experts at state emergency medical services and long-term care organizations/agencies in combination with a review of relevant state law.

Systematic Review of Educational Interventions for Improving Advance Directive Completion

“…One intervention, the Physician Orders for Life Sustaining Treatment (POLST) program, has been used successfully in the United States to streamline a comprehensive plan for end‐of‐life care, with written advance planning as the first step. An essential component of POLST is successfully implementing the end‐of life plan as the patient moves between different treatment settings (Hickman, Sabatino, Moss, & Nester, 2008). Countries and communities discussing ADs should look to the POLST for guidance about significant end‐of life issues, like advance planning and patient‐focused end‐of‐life treatments.…”

Preferences for Resuscitation and Intubation Among Patients With Do-Not-Resuscitate/Do-Not-Intubate Orders

“…30 The POLST paradigm is designed to improve end-of-life care by converting patients' treatment preferences into physician orders easily transported with the patient across a variety of clinical care settings. 31 As of 2012, 14 states have fully endorsed POLST or MOLST programs, whereas another 26 states have similar programs in development. Early evidence suggests important improvements of the POLST approach over traditional DNR/DNI methods of communicating and implementing patient end-of-life care preferences, although further study is necessary.…”

“…The diversity of our patient population was limited. Future studies (20)(21)(22)(23)(24)(25)(26)(27)(28)(29)(30)(31)(32)(33)(34)(35)(36)(37) should assess potential associations between code status and preference discrepancies and race/ethnicity. Previous investigators' work suggests that patient preferences depend heavily on how scenarios are described to patients.…”

Advanced care planning in health service users

“…The end product is a brightly coloured document that delineates treatment orders for CPR, intensity of medical interventions and artificial nutrition. The intent is for the document to be completed ‘based on conversations among health professionals with the patient and/or the appropriate proxy decision‐makers, in conjunction with any existing advance directive for incapacitated patients (Hickman et al. 2008, p. 119)’.…”