October 2021

Discordance and Concordance Between POLST Orders and Current Treatment Preferences

The Journal of the American Geriatrics Society recently published a series of articles by Dr. Susan Hickman et al. that discussed factors related to concordance between POLST and current treatment preferences and identification of reasons behind POLST discordance. The article titled “Factors associated with concordance between POLST orders and current treatment preferences” concluded that less than half of all POLST forms were concordant with current preferences except when orders reflected preferences for comfort-focused care. In the article titled “Reasons for discordance and concordance between POLST orders and current treatment preferences”, highlights that problems with structures and processes to support high quality ACP in nursing facilities. The article discussed key factors for POLST discordance and current treatment preferences which included: problematic nursing facility practices related to POLST completion, missing key information about POLST treatment decisions, and changes over time. 

These findings emphasize the need for appropriate policies and practices to improve the quality of POLST use in nursing facilities and complement previous research as described in Dr. Susan Tolle’s editorial published in the Journal of the American Geriatrics Society entitled “Aligning POLST orders with wishes: Time to put evidence into practice”. 

POLST Is More Than a Code Status Order Form: Suggestions for Appropriate POLST Use in Long-Term Care

The Journal of Post-Acute and Long-term Care Medicine recently published an article which details the problems with POLST use in nursing homes, the reasons that POLST is used as a default code status order form, the risks associated with this practice, and recommendations for nursing homes to implement appropriate use of POLST. The full article can be accessed here. 

Coalition for Quality at End-of-Life (CQEL)

The Coalition for Quality at End-of-Life (CQEL) convened the annual POLST update on Thursday, June 24th with a session that featured presentations and discussions by Dr. Susan Tolle, Chair of the Oregon POLST Coalition and Director of the Center for Ethics in Healthcare. Dr. Tolle’s presentation “Aligning POLST Orders with Wishes: Time to Put Evidence into Practice” who discussed different states’ approaches to POLST quality assurance activities. Presentation materials are available upon request – please contact info@papolst.org for more information.

Update on POLST Curriculum Redesign

The Jewish Healthcare Foundation and Pennsylvania POLST have been awarded a grant from the McElhattan Foundation to support efforts to enhance access to POLST education for providers across the state. PA POLST is working to update the POLST: Doing It Right! in-person training course and adapt all modules to create a self-paced learning experience. New modules are also being added to the curriculum with include:

• CPR Conversions
• EMS & POLST
• Cultural Humility
• Pediatric POLST
  
  

 This month, PA POLST will convene the statewide POLST Curriculum Committee to review current progress of curriculum redesign and provide expert feedback ahead of POLST Course beta-testing aimed to take place later this fall. 

Additional information about accessing the new education modules will be available Fall 2021. 

Upcoming Webinars

National POLST is hosting a five-part webinar series to promote the National POLST Technology Guide. The next webinar in the series on Tuesday, October 12th at 3:30pm EST will explore the role EHRs play in POLST technological interoperability and how to advocate for POLST inclusion into EHRs at a system level. Register here or view the list of upcoming and previous webinars on the National POLST website.

Pediatric Palliative Care Coalition is conducting a Pediatric Palliative Care Webinar Series to increase pediatric palliative care visibility and enhance clinician’s competency. You can register here for upcoming webinars such as Bereaved Parents View on End of Life on Tuesday, October 19th at 3:00pm EST.

Thank you for your continuing support of POLST.

Judith Black, MD, MHA

National POLST Plenary Assembly

Jewish Healthcare Foundation Medical Advisor

blackjs352@gmail.com

PA POLST Coordinator

info@papolst.org

Coalition for Quality at the End of Life (CQEL)

Jewish Healthcare Foundation

EQT Plaza

625 Libery Ave, Ste. 2500

Pittsburgh, PA 15222

412-594-2550

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