ABCD Exchange : January 1999 : Research - Oregon's Physician Orders for Life-Sustaining Treatment Document
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Research - Practice Guidelines
On the Hill - EOL Issues
Lunch Bunch - Second Meeting
Arts - Healing by Killing
Study Shows Oregon's Physician
Orders for Life-Sustaining Treatment (POLST) Document Prevents Unwanted
Interventions
by Janice Lynch Schuster
Oregon uses the one-page Physician Orders for Life-Sustaining Treatment
(POLST) Document to help health care providers honor patient’s treatment
wishes. Printed on shocking pink cardstock, the form is attached to the front
of medical records in hospitals and nursing homes. The document is a physician
order that records patient preferences and treatment intentions and is meant to
enhance the appropriateness and quality of care. The form contains specific
orders on whether a patient wants to have resuscitation and the nature of
medical interventions to be used, including antibiotics and feeding procedures.
According to a 1998 study by the Center for Ethics in Health Care at Oregon
Health Sciences University, POLST is effective at limiting unwanted treatments.
Of 180 nursing home patients who had indicated DNR on their POLST, not one
received CPR, was admitted to the ICU, or received ventilator support. Only 2
percent were hospitalized to extend life. Of the 38 people who died during the
year of the study, 63% had an order for narcotics, and only two died in an
acute care hospital.
Dr. Susan Tolle, director of the Center, reports that the study "shows
. . . that the POLST form focuses efforts on the patient’s comfort, creating a
positive plan that serves the patient." Tolle believes several features of
the form make it effective:
- It is standardized statewide, improving the likelihood that
it will be recognized and respected.
- Its shocking pink color cannot be ignored.
- The orders to limit life-sustaining treatment are clearly
printed on the front, making them easily located.
- The form is written in plain English, making it easy for
staffs of nursing homes, home hospices, home health agencies, as well as covering
physicians, to understand it.
- The specific language requiring comfort measures encourages
attention to pain and suffering—and to their relief.
However, Tolle notes that POLST is so effective because of a five-year,
statewide education initiative, as well as Oregon’s commitment to providing
resources to support patients dying at home.
The POLST document was developed in response to concerns about problems in
respecting DNR orders when patients were transferred from nursing homes to
hospitals. The document is meant to reduce unwanted transfers and, for most
patients, limit intensive medical interventions. To date, 175,000 forms have
been distributed statewide, and hundreds more have been distributed around the
country.
Oregon has taken another approach to honoring patient wishes by redefining
the scope of practice for EMTs and first responders, and their supervising
doctors. EMTs and others are now directed to respect patient wishes for
life-sustaining treatments and to comply with physician orders, such as those
in the POLST Document.
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This content is provided by Americans for Better Care of the Dying. For more information, visit www.abcd-caring.org.