An Oregon-pioneered program aimed at improving health care for those with advanced illness has received financial support to further expand across the nation. The POLST (Physicians Orders for Life-Sustaining Treatment) program was created almost 20 years ago to more accurately honor the treatment wishes of patients with advanced progressive illness or frailty. This week, the POLST program was awarded a $597,765 grant by The Retirement Research Foundation, a Chicago based philanthropic foundation, to support intensive mentorship of POLST Programs in other states.
Oregon Health & Science University’s Center for Ethics in Health Care will coordinate the three-year project. The center will engage health care leaders from the five states with the most experienced POLST Programs (Oregon, California, New York, West Virginia and Wisconsin) to assist additional states in advancing their POLST Programs. The center will offer awards to foster innovation in state POLST projects and to foster cross state collaborations. The center will also continue to provide technical support to states seeking to be endorsed as POLST Paradigm states.
“Oregon and other states with established POLST programs have witnessed significant health care system improvements in the more respectful treatment of those with advanced progressive illness or frailty,” said Susan Tolle, M.D., director of the OHSU Center for Ethics in Health Care. “The lessons we have learned can greatly aid other states in improving, creating or expanding their own programs. This important grant will help better honor the wishes of thousands of patients across the country.”
“Too many people who prefer to have comfort care only end up dying in severe pain, or with high-technology supports that limit quality of life during their remaining days,” said Nancy Zweibel, Ph.D., senior program officer for The Retirement Research Foundation. “While some want all possible means of life extension, those who do not will benefit from POLST by having health professionals certify their preferences and agree to honor them – vital steps for assuring that patients’ wishes are honored. Oregon’s POLST program leadership has set the standard for this approach, which the Foundation hopes can be adopted more broadly. ”
At the center of the POLST program is a document, which allows a patient to work with their health care professionals to form medical orders. These medical orders then can be accessed at a time of need, for instance when paramedics arrive in the home of a person in the midst of a medical crisis.
"POLST differs from advance directives in that the program is geared towards those with advanced illness or frailty, meaning that patients are likely able to foresee the kinds of medical interventions they might require and request or limit the interventions based on their own personal wishes," explains Margaret Murphy Carley, associate director of the OHSU Center for Ethics in Health Care.
OHSU's ethics center worked with others to generate the program, which is now approaching its 20-year milestone. The center also serves as the state's coordinator for the program.