All too often, conversations about the intensity and type of medical interventions patients want at the end of their life fail to occur. In part this is because death is not easily accepted; it's also due to a health care system that rarely asks patients what they want. Yet without these conversations, and a way to document them, patients can end up on a runaway medical train, undergoing ineffective, unwanted, painful, and expensive treatments while their psychological, emotional, and spiritual needs are poorly addressed.

To help patients have their say if they are unable to speak, CHCF has supported the use of Physician Orders for Life-Sustaining Treatment (POLST). POLST is a standardized medical order form that indicates the specific types of life-sustaining treatment a seriously ill patient does or does not want.

In the video below, the POLST form is discussed by Sister Martin de Porres Coleman, resident and care coordinator at Mercy Retirement and Care Center in Oakland, California.

What makes POLST powerful in California is that, unlike a health care directive, it is signed by the patient and physician and becomes a set of medical orders. And unlike a directive, the POLST form moves with the patient as part of the medical record and must be honored across all care settings. When used with an advance directive that names a proxy decisionmaker, POLST can reduce unwanted or medically ineffective care, reduce patient and family suffering, and ensure that patients' wishes are honored at the end of life.

Currently 32 states have implemented POLST or are developing similar programs. A California law in effect since 2009 requires that POLST be honored in all care settings and gives immunity to providers who honor a POLST document in good faith.

Since August 2007, CHCF has supported POLST adoption by:

• Promoting statewide awareness through a comprehensive communications strategy and a stakeholder taskforce
• Creating a standardized approach to implementation with hands-on education and uniform materials
• Stimulating adoption through the efforts of localized POLST coalitions
• Examining our effectiveness through an evaluation underway by the University of California, Los Angeles

Leadership and oversight of these activities is provided by the Coalition for Compassionate Care of California, with support from consultants and others. The Coalition supports local groups to promote adoption of POLST by hospitals, skilled nursing facilities, emergency medical services, and home health care agencies.

Over the past four years, CHCF has funded these coalitions (*funding through 2012):

1. Alameda-Contra Costa Medical Association, Alameda & Contra Costa Counties*
2. Anderson Valley Health Center, Mendocino County
3. Brentwood Biomedical Research Institute, West Los Angeles
4. Central California Valley Coalition, Fresno, Kings, Madera, Mariposa, Merced, & Tulare Counties
5. Community Network for Appropriate Technologies, Sonoma County
6. Compassionate Care Alliance, Monterey County
7. Eskaton, Sacramento County
8. Greater Bakersfield Better Care Coalition, Kern County
9. Hospice of Santa Cruz, Santa Cruz County
10. Humboldt-Del Norte IPA, Del Norte & Humboldt Counties
11. Huntington Memorial Hospital, Pasadena
12. Inland Empire Palliative Care Coalition, San Bernardino County*
13. Monarch Healthcare, Orange County*
14. Queen of the Valley Medical Center, Napa County
15. Riverside County Physicians Memorial Foundation, Riverside & San Bernardino Counties
16. San Diego County Medical Society, San Diego County*
17. San Francisco Medical Society (with the Metta Foundation)*
18. Stanislaus POLST Coalition
19. Valley Care Community Consortium, San Fernando Valley
20. Ventura County Medical Association, Ventura County*
21. VMC Foundation & Santa Clara County Medical Center, Santa Clara County*
22. Woodland Healthcare Foundation, Yolo County

For more information on POLST, see the External Links below.