POLST: Respecting our wishes at the end of life

 

Helen Hobbs clearly expresses her opinions to Dr. Erik Fromme. Her Physician Orders for Life-Sustaining Treatment (POLST) orders reflect her wish not to have CPR and to avoid treatment in the intensive care unit. Helen stars in a video about the POLST Program titled, “Understanding POLST”. Over the past several years, she has helped to develop materials that explain the difference between POLST orders and an Advance Directive.

Helen knows that some people in her retirement community are too healthy to have a POLST form. POLST is intended for those with serious illness, such as advanced heart disease or cancer that has spread, or for those, like Helen, who might be older and frail. POLST orders give you more control over the treatments you do or do not want to receive in an emergency situation. The form works to guide treatment decisions if you get too sick to speak for yourself. Since POLST is a signed medical order that will be followed in an emergency, it is important that it reflect your wishes now, in your current state of health.

POLST is not for everyone. For example, most people in their 60’s are too healthy to need a POLST form. If something suddenly happened, most young and healthy seniors would want everything done while more was learned about what was wrong and their chances of recovery. Healthy people should instead complete an Advance Directive. Later, when they become sicker or frailer, they or the person they appointed on their Advance Directive can meet with their doctor and together complete a POLST form. Having signed medical orders is important for those who wish to avoid CPR. New federal regulations require all assisted living and skilled nursing facilities to provide CPR to every resident unless they have signed medical orders authorizing the facility not to attempt resuscitation, also called a Do Not Resuscitate (DNR) order.

If you feel like you would be a good candidate for a POLST form, you will need to have a conversation with your health care professional about your treatment options. This will include talking about what you value most, including whether comfort measures and being with family are most important to you, or how hard you wish to fight to live a little longer in the face of bad odds. Make sure you talk frankly with your health care professional about the treatments you want or don’t want, and how likely treatments are to work for you. Having an in-depth conversation about your treatment options will better ensure that your health care professionals and loved ones understand your wishes.

The POLST form provides a framework for having and documenting this important conversation and has been shown to be remarkably effective in assuring treatment wishes are honored. In a study of 18,000 Oregonian’s with a POLST form in the Oregon POLST Registry, most got their wish for the level of treatment they wanted. Those who wanted more treatment received it and those who wanted the focus of their care to be on their comfort were able to avoid unwanted hospitalization at the end of their lives. Learn more about POLST by going to www.orpolst.org.