Case Management

Discussing palliative care requires a delicate approach

Case Management Monthly, April 1, 2011

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To relieve family members of the burden of ­endof-life decisions, some patients make their wishes known in advance. One of the newest tools to help ­patients make those wishes known to ­family and care providers is the Physician Orders for ­Life-Sustaining Treatment (POLST) program.

According to the ­California POLST Education Program, a POLST form is a statewide mechanism for an individual to communicate his or her wishes about a range of ­life-­sustaining and resuscitative measures. Patients fill out a form that converts their wishes ­regarding life-­sustaining treatment and resuscitation into ­physician orders that are honored across treatment settings.

Thirteen states and regions in the country have endorsed POLST programs. Several other states are in the process of developing programs.

While it is similar to do not resuscitate (DNR) forms and living wills, the POLST form is more specific, says Todd Cook, MBA, CHCQM, FAIHQ, director of care management at Santa Barbara (CA) ­Cottage Hospital. The POLST form covers a wide array of life-saving treatments, including hospice care, ventilator treatment, and ­feeding tubes. The creators of the POLST form intended for it to be reserved for patients that are medically frail, have a serious health condition, or are diagnosed with a chronic progressive illness. The form should only be used for patients physicians expect will die within a year, according to the California POLST Education Program.

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