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National Report Highlights Oregon Program That Allows Patients Greater Control Of Their Health Care

Special Hastings Center Report highlights Oregon's POLST form as a national example of successful advance directive.

A national report highlights Oregon's Physician Orders for Life-Sustaining Treatment (POLST) program as an effective tool in honoring individual treatment preferences near the end of life. The special Hastings Center Report, "End-of-Life Care: Why Has It Been So Difficult?," will be released nationally on Thursday, Nov. 10, and features a chapter on the POLST program, "Hope for the Future: Achieving the Original Intent of Advance Directives." Oregon Health & Science University (OHSU) researchers joined with end-of-life care leaders from Wisconsin and West Virginia to write the article.

"Advance directives were initially developed as a way for people to maintain control over their medical decision making near the end of life," said Susan Hickman, Ph.D., an assistant professor in the OHSU School of Nursing, senior scholar in the OHSU Center for Ethics in Health Care. "Unfortunately, research suggests these legalistic tools are not very effective. As a result, clinicians have developed alternative models. The most widely studied and used model is the Oregon POLST Program."

The POLST Program was created by a coalition of Oregon health care professionals in the early 1990s to ensure patient treatment preferences are known and honored. The centerpiece of the program is the bright pink POLST medical order form. POLST allows seriously ill people 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.

Since its creation, the idea has spread across the country. More than a dozen states are now using the program either statewide or regionally.

"The POLST form converts patient treatment preferences into medical action in life's final chapter," said Susan Tolle, M.D., director of the OHSU Center for Ethics in Health Care and report co-author. "By documenting these preferences in a consistent format recognizable through the health care system, we help ensure these preferences will be honored even when a person can no longer speak for him or herself." The ethics center led the coalition that originally created the POLST form and continues to oversee the program in Oregon as well as maintain the Web site at

The Hastings Center Report highlighting the POLST program comes on the heels of a $1.3 million grant to the OHSU School of Nursing to further study the use and effectiveness of POLST in nursing homes throughout Oregon, Wisconsin and West Virginia. Hickman is principal investigator of this research funded by the National Institute of Nursing Research, a component of the National Institutes of Health. Researchers will study a variety of issues, including the extent of use of the program in states where it has been implemented and how POLST compares to traditional end-of-life care planning such as advance directives.

Additional authors of the POLST chapter in the Hastings Center Report are end-of-life care leaders Bernard Hammes, Ph.D., of Gundersen Lutheran Medical Foundation and Health System in Wisconsin; and Alvin Moss, M.D., of West Virginia University. Both Wisconsin and West Virginia are two of the many states that now use the POLST after adapting it to fit their states' unique needs and laws.

"Improving End-of-Life Care: Why Has It Been So Difficult?" is a special supplement to the November/December 2005 issue of the "Hastings Center Report" and is made possible by a grant from The Robert Wood Johnson Foundation. It features 10 articles by some of the nation's most influential thinkers who have helped shape the ethical and legal framework on end-of-life care during the past two decades. The report can be downloaded at

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