Portland, Ore.

Oregon's popular, pink POLST form directing end-of-life care receives national attention

A decade ago it was not uncommon for terminally ill Oregonians to receive unwanted aggressive medical care at the end of life. Portland resident Lisa Andrus-Rivera knows firsthand the distress such treatment can cause. After her father collapsed on the floor of his home, emergency medical technicians (EMTs) tried to revive her father for a full half hour. "It was a traumatic experience as emergency workers tried to resuscitate my father in front of the family," said Andrus-Rivera. The advance directive explaining his wishes to avoid such measures could not be located in its time of need. Even if it had been found, the directions it contained were not medical orders and could not be followed by EMTs.

Ten years later, much has changed thanks to the Physicians Orders for Life Sustaining Treatment (POLST) form, an immediately recognizable, double-sided pink form that spells out a person's wishes in their final days, hours and minutes of life. A group of concerned health care providers representing medicine, nursing, hospice, emergency services and long-term care created the POLST to avoid situations like the one the Andrus family experienced, and to ensure that Oregonians wishes for end-of-life care were honored. This month marks the 10-year anniversary of the formation of that group, now called the POLST Task Force. In honor of the anniversary, the task force has released a report titled "A Decade of POLST in Oregon."

The report discusses the history and expanding use of the POLST form. It also examines the success and research surrounding the program. Physicians, nurses and other caregivers across the state will receive the report during the week of Oct. 15.

The POLST form is unique because it contains medical orders. The form is completed based on patient wishes for resuscitation, medical interventions, antibiotics and artificial feedings, and then signed by a physician, turning patient wishes into orders. In long-term care facilities, the POLST form is placed at the front of residents charts where it can quickly be found by facility staff. When a patient is transferred from one health care setting to another, the form goes with the patient. At home, the POLST form is placed in a red envelope and posted on the refrigerator or in another visible location so that it can be located quickly by EMTs.

"Prior to POLST implementation, sometimes paramedics would be called to the home of a person who was terminally ill and find that because they did not have documentation from a physician of the person's wishes, they were required to do things that they knew the patient and family did not want," explained Terri Schmidt, M.D., a member of the POLST Task Force and an emergency room physician at OHSU. " With POLST, they now know what the person wants. Paramedics want to help people and provide the care they would want, but often felt helpless before."

According to the decade report, although the POLST form was initially launched in the Portland metropolitan area, in Bend and in the coastal community of Coos Bay, its popularity has spread.

"Currently the POLST form is available in almost every community across the state," explained Susan Tolle, M.D., editor of the decade report, a member of the POLST Task Force and director of Oregon Health & Science University's Center for Ethics in Health Care. "In addition to its popularity in Oregon, the form is receiving national and international attention."

To date, 40 different states and several foreign countries have requested information about POLST. Currently Wisconsin, West Virginia and New Mexico are using Oregon's form, or their own versions of the POLST, to direct care in their states.

Among the other highlights of the report:
A recent study involving 58 older adults enrolled in an all-inclusive care program found that POLST instructions for CPR, antibiotics, IV fluids and feeding tubes were followed more closely than advance directive instructions. ye Oregon emergency medical workers and OHSU medical residents receive training on use of the POLST form. Educational resources are available for other interested health care professionals. ye The form is useful for seriously ill patients, including dying children.

Since its creation, the powerful impact of the POLST form has been immeasurable. In addition to guiding health care providers, the form provides peace of mind to those patients and families who use it. "The POLST form provides people with the assurance that their treatment wishes will be honored even when they are unable to speak for themselves, enhancing quality of life," notes Patti Fox, social services director at Nehalem Valley Care Center in Wheeler, Ore.

Andrus-Rivera is grateful that the POLST form was available for her mother, who died a few years after her father. Unlike her father, her mother's wishes for treatment were honored. "It was a profoundly moving experience thanks to the POLST form. She died in a much more peaceful setting."

EDITORS: To obtain a copy of the report, please contact Jim Newman in University News and Publications at 503 494-8231. Copies for use in the medical community can be obtained by calling OHSU's Center for Ethics in Health Care at 503 494-4466. Additional information about the POLST program is available at www.ohsu.edu/ethics/polst.htm .

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