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OHSU To Lead A National Study Of Program That Converts Patient Wishes For Life-sustaining Treatments Into Medical Orders

Research project will be conducted in three states now using the program: Oregon, Wisconsin and West Virginia.

Oregon Health & Science University's School of Nursing has received a $1.3 million dollar grant to study the use and effectiveness of a unique end-of-life program developed in Oregon called the Physician Orders for Life-Sustaining Treatment Program, or POLST. The funding for this research project comes from the National Institute of Nursing Research, a component of the National Institutes of Health.

The POLST Program was created by a coalition of Oregon health professionals in the early 1990's to ensure patient treatment preferences are known and honored. The centerpiece of the program is the brightly colored POLST medical order form. The program allows seriously ill persons to direct their end-of-life care by developing a detailed care plan with their health care provider and recording these preferences on the POLST form. The form is then signed by their physician or nurse practitioner, turning preferences into medical orders. POLST forms provide specific instructions about treatments that are wanted and those that are not. These treatments may include cardiopulmonary resuscitation, hospitalization, antibiotics, and feeding tubes.

Because the POLST form travels with a person from nursing home, to hospital, to other health care settings, they are particularly useful in cases where input about health care options is immediately needed. For instance, if a seriously ill person is incapacitated when paramedics arrive, the form provides the emergency medical technicians with orders for treatments that are consistent with patient preferences.

"More than a dozen states are currently using the POLST either statewide or regionally," explained Susan Hickman, Ph.D., an assistant professor of nursing in the OHSU School of Nursing and the principal investigator for the study. "Several studies have been conducted on the POLST Program in Oregon. However, as use of the program grows, it is important for us to measure its usefulness and impact in different communities around the country."

Hickman and the OHSU School of Nursing will collaborate with Susan Tolle, M.D., director of the OHSU Center for Ethics in Health Care to conduct the research. The ethics center led the coalition that originally created of the POLST form and continues to oversee the program in Oregon. Alvin Moss, M.D., of West Virginia University, and Bernard Hammes, Ph.D., of Gundersen Lutheran Medical Foundation and Health System in Wisconsin, also serve as co-investigators on this study.

The research will specifically focus on residents of nursing homes in three states: Oregon, where POLST was launched more than a decade ago; Wisconsin, which initiated the program 8 years ago in some regions of the state; and West Virginia, which launched a statewide program similar to POLST 3 years ago.

The researchers will work closely with nursing homes and long-term care advocacy groups in each state to assess:
* The extent of use of the program in states where it has been implemented;
* How POLST compares to traditional end-of-life care planning such as advance directives; 
* How POLST affects symptom management;
* How the care of patients with POLST forms differs from patients who do not take part in the program. For instance, are their preferences for life-sustaining treatments honored more frequently?
* How the POLST form is related to national end-of-life care statistics. For example, in the state of Oregon researchers hope to determine whether POLST usage is related to the state's low rate of in-hospital deaths.

To gather the data for this study, researchers will conduct phone surveys to determine which nursing homes are currently using the form and which are not. Permission will be sought from a subset of facilities to conduct reviews of medical charts to assess the effect on resident's health care.

"This research will gather plenty of useful data for states currently using POLST as well as for states that are considering implementation," said  Tolle. "Overall, we hope some of the lessons we learn through this research will aid all states in improving their end-of-life programs."

For additional information on the polst program visit WWW.POLST.ORG.


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