Patients get new option to direct end-of-life care
| Wednesday, Apr 15 2009 05:39 PM
Last Updated Wednesday, Apr 15 2009 05:39 PM
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About POLST
To learn more about POLST or download the form, visit www.finalchoices.org. You can also obtain answers to questions by contacting the Kegley Institute of Ethics at 654-3149.
Talking about death is never easy but there's new reason to consider having the discussion.
A state law that took effect this year now requires medical professionals to comply with Physician's Orders for Life-Sustaining Treatment -- a document that elderly or seriously ill patients complete with their doctor to specify their wishes for end of life treatment.
The POLST, as it's known, is a double-sided form usually printed on bright fuchsia paper. It clearly indicates medical actions to be taken or withheld in an emergency, including the patient's desire for procedures such as CPR, feeding tubes, intubation and defibrillation, and whether the patient wants to be transferred to a hospital or not.
And because it's signed by a physician, it carries the weight of a medical order and is more likely to be followed.
"Physicians are much more likely to follow an order signed by another physician than by a patient," said Christopher Meyers, director of the Kegley Institute of Ethics at Cal State Bakersfield, who also sits on several local hospital ethics committees.
POLST is also considered a better way to communicate a patient's wishes than existing forms. For example, advanced health directives are often either too specific or too vague when it comes to certain procedures, said Dr. Jennifer Black, a local palliative care specialist with Kaiser Permanente.
"I've seen patients with a 30-page advanced health directive," said Black, noting the documents often contain confusing information. "Having the POLST, a form that's standardized and recognizable, it's hard to miss if that box is checked."
POLST won't replace advanced directives or living wills, Black said, but will complement them by making the patient's wishes easier to understand.
In Oregon, where POLST was developed, studies have shown compliance with patient's wishes were matched 90 percent of the time with a POLST.
Black and Meyers are leading the effort locally to educate healthcare providers about the document on behalf of the Greater Bakersfield Better Care Coalition, which includes local hospitals, hospice providers and health agencies. The campaign is funded with $40,000 from the California HealthCare Foundation.
They are also encouraging doctors to discuss the form with patients, though patients are also encouraged to raise the topic themselves. Black said she recommends patients make a specific appointment to discuss the form with a physician.
Nona Tolentino, director of Kern County's Long-Term Care Ombudsman Program, said the form is already in use in some area nursing homes but training of medical staff is necessary to make POLST a success.
"It's always great to have a good document but if the medical providers aren't attentive to that, it's just one more piece of paper," she said.
