Let’s Talk: Why Pennsylvania Needs POLST

November 28, 2017

Honoring patients’ end-of-life health care wishes is easier said than done. Even when patients and families have had those difficult conversations, and documented them in the form of advance directives, the complexity of modern health care can let them down.

Pennsylvania Orders for Life Sustaining Treatment, or POLST, take a step forward in helping very ill patients whose health is deteriorating talk about, and get, the kind of end-of-life care they want.

Many Pennsylvania hospitals and health systems use some form of POLST. Doctors and other clinicians, patients, and families find the orders invaluable as tools for starting and guiding meaningful discussion about exactly what medical measures are to be taken to sustain patients’ lives. As one family member quoted in this study put it:

“… I just felt really good when we came away from there with the care plan. We knew what my mother wanted and we kind of knew what we felt was best for her, but it felt really good having it actually put down in paper that there is a plan that other hospitals and nursing facilities can follow.”

Now the Pennsylvania health care community, including associations representing hospitals, physicians, and others, want to go further. They are pressing for state law to standardize the use of POLST across the board in all kinds of health care settings, including emergency medical services (EMS), hospitals, nursing homes, hospice, and home care.

We need this law because right now:

• Some patients are offered the voluntary option of learning more about POLST, but others are not
• Patients’ POLST wishes documented in hospital records may be absent, overlooked, or perceived to lack sufficient legal authority when discharged patients receive care elsewhere
• Without issuance of a Do Not Resuscitate order, the EMS system cannot recognize POLST, even though during transport emergency medical technicians care for patients in life and death situations
• POLST options and how they are documented vary from provider to provider

The proposed POLST law would:

• Reinforce that POLST is voluntary: clinicians and insurers can invite, but cannot require, patients and families to learn about POLST and document their POLST decisions
• Encourage more clinicians to talk to patients and families about end-of-life care: studies show that patients want this conversation, but they want clinicians to start it
• Make POLST self-executing, so orders would apply across all health care settings, regardless of where patients’ POLST decisions were documented and which physicians or advanced practitioners signed them
• Make sure that the EMS system is able to recognize POLST

The proposed legislation would also charge the Pennsylvania Department of Health with developing and maintaining POLST documentation and clinician education, to speed adoption and streamline implementation.

As a state and nation, we are making progress in defining and getting the kind of end-of-life care we want. Many more older adults now have advance directives in place at the time of their death.

A POLST law for the commonwealth would help us get even better at making sure our end-of-life health care wishes are understood and followed.

I can testify to how much Maryland’s version of POLST, called Medical Orders for Life-Sustaining Treatment, helped my dad get the care he wanted as his life ended. I thank Senator Gene Yaw (R-Lycoming County) and Representative Bryan Cutler (R-Lancaster County) for sponsoring POLST legislation here in Pennsylvania.