Project

Physician Orders for Life-Sustaining Treatment (POLST)

Physician Orders for Life-Sustaining Treatment (POLST), a standardized medical order form printed on brightly colored paper, indicates which types of life-sustaining treatment a seriously ill patient wants or doesn't want if his or her condition worsens. Too often, necessary conversations about end-of-life medical interventions and intensity of care don't occur. The POLST form, signed by both the physician and the patient, becomes a tool to capture these discussions and make them part of the patient's medical record. The form moves with the patient and must be honored across all settings of care.

Thirty-two states have implemented POLST or are developing similar programs. Since January 2009, California law requires that POLST be honored across all settings of care and provides immunity to providers who honor a POLST document in good faith.

In August 2007, CHCF committed $120,000 to promote the establishment of POLST in some communities of California. The Coalition for Compassionate Care of California is managing the process of supporting seven local coalitions to introduce the POLST form in their communities and the establishment of a taskforce of California stakeholders (hospitals, physicians, nursing homes, emergency services, and consumers). The seven initial sites selected were:

1. Alameda-Contra Costa Medical Association, Alameda County
2. Anderson Valley Health Center, Mendocino County
3. Channel Islands POLST Group, Ventura County
4. Humboldt Independent Practice Association, Humboldt County
5. Inland Empire Palliative Care Coalition, Riverside County
6. VMC Foundation and Santa Clara County Medical Center, Santa Clara County; and
7. Woodland Healthcare Foundation, Yolo County.

In June 2008, CHCF expanded this effort with the goal of eliciting and honoring patients' wishes for treatment at the end of life by spreading the POLST model throughout California. CHCF has committed up to $2.14 million over four years. The goal is to build momentum with an initial focus on nursing home residents and culminating in statewide adoption of POLST in California by 2012. The project has three strategies:

• Increase efforts to implement POLST in local geographic areas
• Create a standardized approach to simplify POLST implementation, and
• Intensify statewide engagement of stakeholders and regulators to sustain POLST implementations.

Leadership and oversight of these activities continues to be provided by the Coalition for Compassionate Care of California with support from consultants and other organizations.

In November 2008, CHCF funded eleven additional community coalitions to implement POLST:

1. Community Network for Appropriate Technologies, Sonoma County
2. Compassionate Care Alliance, Monterey County
3. Greater Bakersfield Better Care Coalition, Kern County
4. Hospice of Santa Cruz, Santa Cruz County
5. Inland Empire Palliative Care Coalition, San Bernardino County
6. Monarch Healthcare, Orange County
7. Queen of the Valley Medical Center, Napa County
8. San Diego County Medical Society, San Diego County
9. Southern California Bioethics Committee Consortium, West Los Angeles
10. Valley Care Community Consortium, San Fernando Valley; and
11. Ventura County Medical Association, Ventura County.

POLST is a vehicle to bring clarity around the difficult decisions for end of life care. When used with an advance directive that names a proxy decisionmaker, it would reduce the initiation of unwanted or medically ineffective care, reduce patient and family suffering, and ensure that patients' wishes are honored at the end of life.