By Elizabeth Hart, MD
The Physician Orders for Life-Sustaining Treatment (POLST) Paradigm program translates patient preferences into actionable medical orders in order to ensure that a patient’s wishes are honored. The POLST paradigm is based on effective communication about goals of care for people with life-limiting illness or advanced frailty. A POLST form is a set of medical orders, which is based on a patient’s preferences for care and is signed by the patient’s healthcare provider; it is printed on brightly colored paper and follows a patient across settings of care. POLST complements conventional advance directives that may not anticipate specific treatment options that may arise and may not be readily translated into orders. POLST orders reflect preferences for cardiopulmonary resuscitation, level of medical intervention – including hospitalization, antibiotic therapy, and artificial hydration and nutrition.
The Maine Hospice Council has continued to provide vigorous leadership for the coalition working to advance Maine’s POLST initiative during the year since adoption of a standardized form for Maine in April 2009. Partnering with MaineHealth and the Maine Health Care Association, the Council has supported training of “conversationalists” skilled in facilitating discussions of goals of care and determining preferences for treatment options. The Maine POLST Coalition is supporting development of policies and procedures for health care facilities, a patient/family brochure and an online educational curriculum for Maine’s EMS providers that will complement extensive ongoing efforts to train physicians, nurses, social workers and chaplains throughout the State in the POLST model. Discussion at an October 2009 retreat and subsequent reflection on the role of a future Maine POLST home led to a consensus among Coalition members that the Council is the best qualified organization in the State to serve this important role, which will include administrative functions, educational initiatives, quality monitoring, community education and advocacy. The Board has approved exploration of options for funding this exciting venture and partnering with other organizations in performing these essential POLST home functions.
- Information from the State of Maine on Advanced Directives can be found at http://www.maine.gov/dhhs/oads/aging/resource/rit2chew.htm
- Print a copy of our Advanced Directives Form