We’ve recently been publishing a series on advance planning and why this is such a critical area.
We also highlighted advance care directives, which are a formal tool for promoting the end-of-life approaches that an individual wants. But, as we highlighted in that post, advance care directives have their limitations. For one thing, they’re often overlooked in the hospital environment, especially when emergency situations arise.
In this post, we want to touch on another angle – an approach that has been examined in research and is used in some environments.
The idea is a POLST form, which stands for Physician Orders for Life-Sustaining Treatment. These forms are created in consultation with physicians and they specify exactly what life saving measures can and cannot be applied.
The forms allow people to determine whether only comfort measures are applied or full life-prolonging interventions – along with options in the middle.
Why Use a POLST Form?
Research shows that POLST forms are more effective at promoting the desired treatment outcomes that traditional advance planning approaches.
One reason is simply that healthcare professionals are more involved. As such, there’s a much greater level of communication and coordination.
POLST forms are typically used in supportive environments, cases where patients already have a healthcare team. This allows for greater predictability. It also means that staff members typically expect there to be a document about end-of-life wishes.
In contrast, patients with advance care directives often end up at hospitals. Their requests can be missed due to paperwork issues or the urgent nature of life-or-death situations.
Something similar can still happen with a POLST form but such issues are less common. This alone makes POSLT forms something to consider.
Limitations of POLST Forms
While they are powerful, POLST forms have their limitations.
They focus on severe illnesses
POLST forms are used when patients are already sick and they’re created in consultation with healthcare professionals. They’re often used in cases where patients are already in a supportive facility of some type.
As a general rule, the forms are used for patients who are not expected to live a year.
Realistically, a POLST doesn’t apply to most seniors, they’re simply too healthy.
The systems aren’t in place yet
For POLST forms to truly be effective, standardized and coordinated systems would be needed. These simply don’t exist, not yet. Various states are making headway in creating systems that span various organization types in the state.
But, those are a long way from being completed. This can create complications for patients who move between facilities.
On a side note – the forms aren’t always called POLST either. Instead, states have different terms, like MOLST, MOST and POST. The general principle is the same regardless, although there may be some differences between one state and the next.
Final Thoughts
The end result is that POLST forms can be powerful. But, the forms don’t apply to every situation and much more work needs to be done before they can be truly effective.
Despite this, it may be worth talking to the senior’s medical team about POLST forms. The forms could be a more effective way to make sure that end-of-life wishes are respected.
Leave a Reply