Featured Research

from universities, journals, and other organizations

New program improves care for those with advanced illness

Date:
January 3, 2012
Source:
Oregon Health & Science University
Summary:
A new program, which was created by health care professionals two decades ago in an effort to ensure the wishes of those with advanced illness are followed, has now spread to 34 states in the United States.

Oregon's groundbreaking Physician Orders for Life Sustaining Treatment program (POLST) is featured in the latest edition of the Journal of The American Medical Association. The program, which was created by health care professionals two decades ago in an effort to ensure the wishes of those with advanced illness are followed, has now spread to 34 states around the country.

The program's key component is an order form that provides clear instruction about the patient's health care preferences to health professionals, such as paramedics and emergency room physicians, when a patient cannot communicate these wishes themselves. The form allows patients to request that they receive or refrain from certain measures such as CPR or intensive care. In addition, Oregon's program includes a registry that offers 24-hour access to emergency workers when the printed form cannot be located.

The JAMA article highlights the latest research to gauge the impacts of the program. That data revealed:

  • 25,142 people were enrolled in Oregon's registry during the first year of operation.
  • 86 percent of patients in the POLST program are 65 or older.
  • 28 percent wished to receive CPR if needed.
  • 72 percent had a "Do Not Resuscitate" order.
  • 50 percent of patients who had a DNR order wanted to be hospitalized.

"Our study shows that resuscitation is not the most important question for people with advanced illness and frailty," said Susan Tolle, M.D., director of the Center for Ethics in Health Care at Oregon Health & Science University and senior author on the study. OHSU administers both the program and the registry. "Not only is CPR unlikely to be successful in patients with advanced illness, but knowing that the patient has a DNR order does not predict what other treatments they want or do not want. Half of patients with a DNR order wanted to return to the hospital and half did not. POLST orders for scope of treatment clarify which patients want to be hospitalized and whether they would want intensive care in a time of crisis."

"The POLST program creates a system that has been shown to have advantages over traditional advance directives and do-not-resuscitate orders by providing a more comprehensive set of medical orders based on patient preferences and ensuring that patients receive the medical treatment they want with a high degree of accuracy," added Alvin H. Moss, M.D., director of the West Virginia Center for End-of-Life Care, which oversees the Physician Orders for Scope of Treatment (POLST) program, a program comparable to Oregon's POLST program, and the WV e-Directive Registry. "The Oregon POLST registry is the final step in completing the system and makes those orders available to treating health care providers in an emergency."

One of the important aspects of the POLST program is its ability to launch important discussions among patients, their loved ones and health care professionals. When these discussions occur in the early stages of advanced illness for frailty, patients can share their wishes in case they are unable to communicate in a time of crisis. In addition, the program offers families some peace of mind because when a patient fills out a POLST form, the burden of family members who previously could only speculate on their loved one's wishes, need not do so anymore.

"One of my colleagues, a rural doctor, taught me not to start my conversations about goals of care with code status," explained study author Erik Fromme M.D., a palliative care specialist at OHSU. "Instead, he said, it should be the last question you talk about. Too often in health care the conversation begins and ends with resuscitation, when it would be much more helpful to know what kind of care a patient wants before they arrest. Our data, and programs like Oregon's support the wisdom of this approach."


Story Source:

The above story is based on materials provided by Oregon Health & Science University. Note: Materials may be edited for content and length.


Journal Reference:

  1. E. K. Fromme, D. Zive, T. A. Schmidt, E. Olszewski, S. W. Tolle. POLST Registry Do-Not-Resuscitate Orders and Other Patient Treatment Preferences. JAMA: The Journal of the American Medical Association, 2012; 307 (1): 34 DOI: 10.1001/jama.2011.1956

Cite This Page:

Oregon Health & Science University. "New program improves care for those with advanced illness." ScienceDaily. ScienceDaily, 3 January 2012. <www.sciencedaily.com/releases/2012/01/120103165008.htm>.
Oregon Health & Science University. (2012, January 3). New program improves care for those with advanced illness. ScienceDaily. Retrieved September 19, 2014 from www.sciencedaily.com/releases/2012/01/120103165008.htm
Oregon Health & Science University. "New program improves care for those with advanced illness." ScienceDaily. www.sciencedaily.com/releases/2012/01/120103165008.htm (accessed September 19, 2014).

Share This



More Health & Medicine News

Friday, September 19, 2014

Featured Research

from universities, journals, and other organizations


Featured Videos

from AP, Reuters, AFP, and other news services

The Cost of Ebola

The Cost of Ebola

Reuters - Business Video Online (Sep. 18, 2014) As Sierra Leone prepares for a three-day "lockdown" in its latest bid to stem the spread of Ebola, Ciara Lee looks at the financial implications of fighting the largest ever outbreak of the disease. Video provided by Reuters
Powered by NewsLook.com
What HealthKit Bug Means For Your iOS Fitness Apps

What HealthKit Bug Means For Your iOS Fitness Apps

Newsy (Sep. 18, 2014) Apple has delayed the launch of the HealthKit app platform, citing a bug. Video provided by Newsy
Powered by NewsLook.com
U.S. Food Makers Surpass Calorie-Cutting Pledge

U.S. Food Makers Surpass Calorie-Cutting Pledge

Newsy (Sep. 18, 2014) Sixteen large food and beverage companies in the United States that committed to cut calories in their products far surpassed their target. Video provided by Newsy
Powered by NewsLook.com
Residents Vaccinated as Haiti Fights Cholera Epidemic

Residents Vaccinated as Haiti Fights Cholera Epidemic

AFP (Sep. 18, 2014) Haitians receive the second dose of the vaccine against cholera as part of the UN's vaccination campaign. Duration: 00:34 Video provided by AFP
Powered by NewsLook.com

Search ScienceDaily

Number of stories in archives: 140,361

Find with keyword(s):
Enter a keyword or phrase to search ScienceDaily for related topics and research stories.

Save/Print:
Share:

Breaking News:
from the past week

In Other News

... from NewsDaily.com

Science News

Health News

Environment News

Technology News



Save/Print:
Share:

Free Subscriptions


Get the latest science news with ScienceDaily's free email newsletters, updated daily and weekly. Or view hourly updated newsfeeds in your RSS reader:

Get Social & Mobile


Keep up to date with the latest news from ScienceDaily via social networks and mobile apps:

Have Feedback?


Tell us what you think of ScienceDaily -- we welcome both positive and negative comments. Have any problems using the site? Questions?
Mobile: iPhone Android Web
Follow: Facebook Twitter Google+
Subscribe: RSS Feeds Email Newsletters
Latest Headlines Health & Medicine Mind & Brain Space & Time Matter & Energy Computers & Math Plants & Animals Earth & Climate Fossils & Ruins