Wednesday, April 12, 2017

POLST: The Actionable Solution to a Universal Question

By: Amy Frieman, M.D.
Hospice and Palliative Medicine

Most of us won’t find it surprising that studies show the vast majority of Americans would prefer to die in their own home, with friends and family by their side, than at a care facility.

When juxtaposed with recent data from the Centers for Disease Control, however, these findings illuminate the sobering reality of the current state of end-of-life care: Although 70% of Americans say they would rather die at home, in actuality, 70% of Americans die in a hospital, nursing home, or assisted-living facility.

Reconciling patients’ care wants/wishes and the reality of care received is part of the rationale behind Practitioner Orders for Life-Sustaining Treatment (POLST), a medical order form that empowers individuals to work closely with their medical team to detail their personal goals and medical preferences when facing a serious illness. 

“It’s a way of honoring the wishes of both the patient who wants the most aggressive interventional treatment to prolong life, AND the patient who wants to spend their last days focused on comfort at home with loved ones,” says Amy Frieman, M.D., Medical Director, Palliative Care, Legacy Meridian Health;  Clinical Assistant Professor, Rutgers and RWJ.

By translating wishes expressed in an advance directive into actionable medical orders, POLST allows patients with serious chronic illness, terminal illness, or those who are elderly and frail to dictate the way that they want to live their remaining days. 

“For physicians, POLST offers an actionable approach for managing the fragile balance between ‘quality’ of life and ‘quantity’ of life,” says Dr. Frieman.  “For patients, it provides an attainable, clinical solution to a universal question: ‘How do you want to live out the rest of your life?’ ”

Thursday, March 30, 2017

Health Care Proxy

By: Celena Romero
Clinical Quality Specialist
Lehigh Valley Health Network

It is very easy to get caught up in day-to-day routine activities. Rarely is there time to think about the “what if” questions until it’s too late. I’m specifically referring to advance care planning. I’d like to share my personal experience that triggered my thoughts of advance care planning at 35 years old.

My husband and I were healthy newlyweds taking our ordinary life for granted until my husband became critically ill with the Swine flu and MRSA pneumonia. Suddenly, I was making health care decisions and signing consent forms on his behalf, as he remained intubated in a medically induced coma. I asked myself, “If we weren’t married who would be making his healthcare decisions? Would it be my husband’s parents; his 18 year old son? Who would these decisions be legally deferred to? Would I be left in the dark as far as his medical care or prognosis?” Fortunately, my husband made a full recovery and is doing exceptionally well thanks to the care he received at Lehigh Valley Health Network. But, I still wonder what things would have been like if we weren’t married during those crucial moments in the intensive care unit.

I also question, “What if I were the one in a coma? Is my husband comfortable making medical decisions on my behalf?” As it turns out, he’s not best suited for the task. I defer my healthcare decision making to my mom. My mom is my health care proxy. Everyone over 18 years old needs a health care proxy - a person who knows your care wishes and will express them to doctors in the event you cannot speak for yourself. This is an example of advance care planning.

The Conversation Project's user friendly guide, How to Choose a Health Care Proxy and How to Be a Health Care Proxy offers facts and tips to make sound decisions about choosing, and being, a health care proxy. This guide can found at http://theconversationproject.org/wp-content/uploads/2017/03/ConversationProject-ProxyKit-English.pdf. For more information about advance care planning, please visit http://yourlifeyourwishes.com/.