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?’ ”

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