Tagged: Chicago End-of-Life Care Coalition

POLST form presented at Northwestern Memorial, a seminar from LMM co-founder Mary F. Mulcahy, M.D.

Image: Mulcahy speaking to a group of physicians at Northwestern Memorial Hospital
Image: Mulcahy speaking to a group of physicians at Northwestern Memorial Hospital

“The Illinois POLST form is a step in the right direction,” said Mary F. Mulcahy, a co-founder of Life Matters Media and practicing oncologist at Northwestern University, while lecturing physicians about the form Thursday at Northwestern Memorial Hospital.

In March, the Illinois POLST form was released to the public, an effort headed by the POLST Paradigm and the Chicago End-of-Life Care Coalition. This update to the Illinois DNR advance directive aims to improve the quality of life for patients at end of life.

POLSTs, Physicians Orders for Life Sustaining Treatment, are more detailed than conventional living wills and advance directives. These forms give patients the freedom to indicate preferences regarding resuscitation, intubation, intravenous antibiotics and feeding tubes. Such forms are intended for patients in their last year of life, and they can follow patients across state care settings and direct doctors to provide or withhold lifesaving treatments.

Image: POLST form
Image: POLST form

The form should be adjusted over time to fit each patient’s prognosis. “This is not a one-time thing, as patients progress the form can change,” Mulcahy said. “There should be shared decision-making between physicians and patients.” To be valid, the form must be signed by the attending physician.

In the U.S., the average patient visits the hospital more than 30 times and meets nine different physicians during the last six months of life. These patients could benefit from having their medical wishes written down and on hand; the convenience helps cut through the chaos and confusion prevalent in care settings.

POLST was developed in Oregon in the 1990s, and now 14 states have POLST programs. Twenty-eight states are considering the use of such forms.

“Hopefully this form will change the culture and get people talking and preparing for the end of life,” Mulcahy said.

Palliative care expert Andrew Thurston, M.D., agreed. “I think this is great. My hope for the POLST form is that it will clarify patients’ wishes for their end of life care, and that it helps doctors more effectively communicate with their patients,” said Thurston. “We need more open discussion, and with easier language, this form helps.”

More about POLST

Washington POLST form: A new bill aims to close loophole

Illinois POLST form released to public

How POLST forms clarify wishes: Three scenarios

More from Life Matters Media:

Death with Dignity: Vermont House to vote amended end of life bill

Google “Death Manager”: A will for your digital data

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“Consider the Conversation”: A discussion at Fourth Presbyterian Church

Film

The acclaimed “Consider the Conversation: A Documentary on a Taboo Subject” was screened at Fourth Presbyterian Church in Chicago on Wednesday, in collaboration with the Chicago End-of-Life Care Coalition.

Directed by longtime friends Terry Kaldhusdal, a fourth grade teacher and filmmaker, and Michael Bernhagen, a hospice advocate, the film showcases  interviews with health care professionals, religious leaders and the terminally ill in order to explain the importance of having the freedom to choose one’s end of life preferences. It also highlights the moral dilemmas surrounding the hastening of death, such as stopping eating and drinking, for those suffering and the artificial prolonging of  life.

Loretta Downs, the CECC president, thanked the audience for being brave enough to watch such an emotionally evocative film. “Now we are living for years with chronic illnesses that before would have killed us.  We think that we will never die, but we are required to talk about end of life,” said Downs, who is also featured in the documentary. “The film has inspired many people to have these conversations.”

The audience seemed to enjoy the film and engaged in a lively conversation afterwards. “I thought it was excellent, said Susan Thompson, 75. “It emphasized being natural in the most difficult moments of death and life.”

Downs acts out planning an advance care directive after film
Downs acts out planning an advance care directive with her colleague Daryl Isenberg, Ph.D., after the film for audience

Laura Pond, 54, said she did not like the film’s stance on hastened death. “I found it difficult to watch because I have a chronic illness and I thought people in the film were giving up,” she said. “You do not give up. It is not God’s plan.”

Marty Preiss, 60, said she found the film both compelling and engaging. She is planning a similar event for a screening at her church in Chicago’s  northern suburbs.

The film has also been well received by health care professionals. “I have never recommended a film on the end of life before. But people deserve to see “Consider the Conversation” because it deepens our passion for life and enriches our lives,” wrote Compassion and Choices’ Barbara Coombs Lee.

“Consider the Conversation” has won  multiple  awards,  including the Award of Excellence in End-of-Life Care from Agrace HospiceCare and the Silver Award of Excellence: Best Documentary or News Special from the Milwaukee Press Club.

Part two: “Consider the Conversation: A Documentary About Unintended Consequences” will be released early next year.

Learn more from the Life Matters Media Newswire:

Psychological responses to end of life

The Breakers offers advice for caring for elderly parents

POLST Illinois moves forward

The Physician Orders for Life-Sustaining Treatment (POLST) program, designed to improve the quality of end of life care, is on its way to Illinois. Health care professionals met at Rush University Medical Center Thursday to discuss the form’s development and strategies for raising public awareness.

Sample POLST

The Chicago End-of-Life Care Coalition sponsored the discussion led by Julie Goldstein, M.D., a clinical ethicist and palliative care physician at Advocate Illinois Masonic Medical Center.

POLST program forms are more detailed than conventional living wills or other advance directives. They allow patients to indicate preferences regarding resuscitation, intubation, intravenous antibiotics and feeding tubes. Such forms are intended for patients in their last year of life, and they can follow patients across in-state care settings and direct doctors to provide or withhold life saving treatment in emergency situations.

For instance, an individual may choose to decline resuscitation efforts, but of for artificial nutrition. An individual may choose artificial nutrition with set limits or permanent placement.

Goldstein answering audience questions

“POLST improves on the existing uniform DNR form,” said Goldstein. “POLSTs are medical orders and have to be followed by all medical care providers.” To be valid, a POLST form must be signed by an attending physician.

Loretta Downs, president of the CECC, told LMM that POLST is essentially about enhancing personal liberty at end of life. “For Illinois, accepting the POLST form is a statement encouraging people to take advantage of their liberty regarding end of life decisions. It empowers the individual to make a clear statement about whether or not he or she wants end of life care and what level of treatments.”

The POLST form will be available in early 2013, a version of the IDPH DNR Uniform Advance Directive. Goldstein said it will be most similar to the California POLST. The final form awaits approval from state health officials and it may be “ultra pink.”

Many in attendance left hopeful that the form would help their patients. Kriston Kurelic, a social worker at Passages Hospice, says she is excited about the form’s implementation. “I’m very interested in the changes that will happen,” Kurelic said. “It will be very beneficial to long-term care. It will be beneficial to patients and families.”

Christine Nelson, director of nursing at Manor Care, agrees. “I think anything that helps us assess what people’s wishes are more clearly is helpful,” she said. “The only barrier I see is time being taken to explain the form to patients.”

The task of educating patients will likely fall on individual health care providers. Because it is a physician order, it is intended to be accompanied by a meaningful doctor-patient dialogue. Carol Blendowski, a Rainbow Hospice nurse practitioner, says time is what is required to have such conversations, but thinks patients will ultimately find the POLST easy to navigate. “I can see clearly now,” she said. “This form is user friendly.”

POLST was developed in Oregon in the 1990s, and now 15 states have POLST programs. Twenty-eight states are considering the use of POLST forms.

Learn more from the Life Matters Media Newswire:

What is palliative, hospice care?

POLSTs work, says Respecting Choices’ Bernard Hammes

POLSTs work, says Respecting Choices’ Bernard Hammes

Dr. Hammes, Illinois Hospital Association conference

Chronically ill patients inadequately prepared for the end of life often receive unnecessarily burdensome care, said Dr. Bernard Hammes, keynote speaker at this week’s Illinois Hospital Association Conference. Hammes, of Wisconsin’s Gundersen Lutheran Medical Foundation, developed the program Respecting Choices to teach clinicians about end of life planning.

Hammes maintains that the POLST paradigm is the best program to fix the problem of inadequate end of life treatment, and practitioners should understand POLST as a platform for cultural transformation.

What is POLST?

POLST (Physician Orders for Life-Sustaining Treatment) was developed in Oregon in the 1990s, and 14 states have enacted POLST programs in the years since. The POLST form is now under consideration for use in twenty-eight other states, including Illinois.

POLSTs are more detailed than conventional living wills, and they differ from advance directives. Patients can indicate preferences regarding resuscitation, intubation, intravenous antibiotics and feeding tubes. The forms are intended for patients whose life expectancy is no longer than one year.

“The purpose of POLST is to provide a mechanism to communicate seriously ill patients’ preferences for end of life treatment across treatment settings and to improve the implementation of advance care planning by being more specific,” Hammes said. “POLST works.”

POLSTs do not carry legal weight across state lines, but the forms can act as guidelines for physicians in any care setting. The POLST form is always intended to travel with a patient- whether by ambulance en route to a hospital, or in the instance a patient moves to a long-term care facility.

POLST Coming to Illinois

“There is a national POLST paradigm initiative, there is a task force, I assume that Illinois will become a recognized member,” Hammes told the room of hospice, palliative care, and general practitioners at Northern Illinois University’s Naperville campus.

The Illinois POLST task force is currently working to assemble and educate health workers statewide about the form. The task force is made up of physicians, public health officials, nurses, chaplains and representatives from the Chicago End of Life Care Coalition.

POLSTs may be available in Illinois as early as January of 2013.

Learn more about the POLST form coming to Illinois here.

Learn more from the Life Matters Media Newswire.

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POLST coming to Illinois

Oregon POLST

The Physician Orders for Life-Sustaining Treatment (POLST) program, designed to improve the quality of end of life care, is on its way to implementation in Illinois. A task force made up of physicians, public health officials, chaplains and nurses is currently working to assemble and educate health care workers about the form.

POLST was developed in Oregon in the 1990s, and now 14 states have POLST programs. Twenty-eight states are considering the use of POLST forms.

POLSTs are more detailed than conventional living wills or advance directives. They allow patients to indicate preferences regarding resuscitation, intubation, intravenous antibiotics and feeding tubes. Such forms are intended for patients in their last year of life, and they can follow patients across care settings and direct doctors to provide or withhold lifesaving treatment.

Julie Goldstein, M.D., a palliative care and clinical ethics specialist at Advocate Illinois Masonic Medical Center, leads the POLST Illinois task force and spoke with Life Matters Media.

“I work at the bedside. I see the results of people not having thought about their future,” Goldstein said. “Their loved ones have to make their decisions at a loss. I think with no directives from the patient, the default approach is maximum treatment, despite burdens and if treatments can help.”

CECC

The Illinois Department of Public Health is currently looking over the proposed form. “Individuals may be able to have the POLST form by the New Year, but we don’t know for sure yet,” Goldstein said.

The Chicago End-of-Life Care Coalition, a non-profit working with the task force, maintains that every person has the right to accept or decline medical treatment. This right is maintained, POLST advocates say, even if a patient loses the capacity to make medical decisions. POLST is just one advance care option.

The POLST form is always intended to travel with a patient, whether that is in an ambulance en route to a hospital, or in the instance a patient moves into a long-term care facility.

“The POLST form differs from a DNR form in that it addresses more life-sustaining treatment options than CPR and is recognized and honored by all institutions along the healthcare continuum in the states where it is utilized,” according to the CECC.

Learn more from the Life Matters Media Newswire.

Unrealistic expectations among the terminally ill

Medical Marijuana: DEA continues to classify cannabis alongside heroin and LSD

POLST excluded from Wis. end of life care program