POLST Captures End-of-Life Care Choices

By Tracy Christner
Project GRACE executive director



Tracy Christner

Very few of us want a state-of-the-art death. You know the kind – with high-tech, aggressive interventions, such as breathing machines and feeding tubes. These devices may keep you alive technically for weeks, months or even years. However, in some circumstances, such as a heart attack, many of us would want CPR. That's where the Physician Orders for Life-Sustaining Treatment (POLST) program comes in.

POLST is designed to help individuals in the last stages of life express their wishes regarding life-sustaining treatment. Suncoast Hospice will be the first hospice in Florida to offer POLST to its patients. The pilot will begin this fall after staff has been trained by Project GRACE, the Suncoast Hospice affiliate leading this effort.

Why POLST Is Needed

Just imagine an elderly man (Mr. M) with advanced dementia living in a nursing home.  His living will requests no CPR and no intensive care. He chose his daughter as his healthcare decision maker.

One Friday evening, Mr. M is found unresponsive with an irregular, weak pulse and extremely low blood pressure. The nursing home is unable to reach his daughter and emergency services are called. The paramedics arrive and Mr. M is resuscitated, intubated and transferred to the local hospital. His daughter learns what has happened and demands to know why his living will was not followed.

Completing a living will is often not enough to ensure that your wishes to have or limit medical treatment will be respected. Living wills are general statements of your preferences but need to be carried out through specific medical orders when the need arises. Without special arrangements, medical orders have limited authority outside of the institutions in which they are written. For example, a physician’s orders at the nursing home usually have no authority in the ambulance or hospital.

Mr. M needed a document with medical orders that were followed at each step of his care, from the nursing home to ambulance to emergency department to intensive care unit. That is what POLST does.

How POLST Works

POLST is an approach to end-of-life planning based on thoughtful, facilitated conversations between patients, loved ones and medical providers. It’s designed to ensure that seriously ill patients can choose the treatments they do and do not want based on their values, personal beliefs and current states of health.

POLST’s several advantages include:

• It’s signed by the healthcare provider. There’s no need for interpretation and translation because it’s an immediately actionable medical order.

• It’s easy to follow because it’s on a single-page, standardized form.

• Unlike DNR (do-not-resuscitate) orders, it addresses not just CPR but an entire range of life-sustaining interventions, such as IV fluids, antibiotics, feeding tubes and artificial breathing.

• It’s transportable. It remains in the patient’s chart and travels with the patient. It’s recognized and honored across all treatment settings.

POLST Provides Peace of Mind

We believe POLST to be the best tool to help our patients and their families achieve peace of mind through shared and informed medical decision making.

Just imagine if Mr. M and his physician had completed a POLST form with orders indicating “Do Not Attempt Resuscitation, Comfort Measures Only and Do Not Transfer to Hospital for Life-Sustaining Treatment.” The covering physician and daughter, who agree with the POLST orders, are called. The daughter understands that her father would be transferred to the hospital if his comfort needs cannot be met at the nursing home. The next morning, Mr. M dies in comfort at the nursing home surrounded by his daughter, other family members and the staff who know him well.

For more information on POLST or Project GRACE, visit www.projectgrace.org/POLST or call (727) 536-7364. You may also read more about POLST in Suncoast Hospice’s recent article in Tampa Bay Medical News.