In 1990, Oregon leaders in clinical ethics, emergency medical services and long-term care recognized that preferences for life-sustaining treatments of patients with advanced chronic progressive illness were frequently not found or not transferable and thus not honored. The Center for Ethics in Health Care at Oregon Health & Science University convened representatives from stakeholder health care organizations to develop the Medical Treatment Coversheet; portable medical orders based on a patient’s values for life-sustaining treatments.
After initial evaluation and a name change to “Physician Orders for Life-Sustaining Treatment” (POLST) the form was released for use in Oregon in 1995. Using a “train-the-trainer” model, members of the task force initially educated health care professionals about use of the form. Ongoing education, research and a statewide experience-based continuous quality improvement process helped the task force improve the content of the POLST Form and the process of implementation.
As Oregon’s program evolved, selected regulations rather than legislation were used to help with implementation. Other programs like West Virginia and New York sought legislation to facilitate POLST Paradigm adoption. Each new program found that their approach needed to be thoughtfully tailored to state laws and regulations.
Mission, Vision & Values Statement
The Mission of the Oregon POLST Coalition is to improve the quality of life for Oregonians nearing the end of life by providing an evidence-based, patient-centered, voluntary process that elicits, records and honors the treatment goals of those with advanced illness and frailty in a compassionate manner that is respectful of the inherent dignity of the individual.
Our Vision & Values
In order to deliver evidence-based, high quality care we will assure the following components are part of the POLST completion process:
- The right patient: the patient will feel empowered by the discussion of the POLST form with their health care professional;
- The right decision-maker: as part of the quality process, and with the patient’s permission, the patient’s correct legal decision-maker will participate in the conversation to assure they know and feel comfortable honoring the patient’s wishes;
- The right time: the healthcare professional would offer the opportunity for a POLST discussion to their patient whom they would not be surprised if this patient were to die in the next 1-2 years;
- The right conversation: the health care professional is trained and experienced in having a sensitive and meaningful “Goals of Treatment Conversation” with the patient and their legal decision-maker; and
- The right documentation: the POLST form will be carefully and correctly completed, submitted to the Registry, and easily available to those who will need to locate and honor the POLST orders across the continuum of care.
Oregon POLST Program Leadership Team
Susan Tolle, M.D., Chair, Oregon POLST Coalition
Susan Tolle is the Director of the OHSU Center for Ethics in Health Care and a practicing internal medicine physician. She is also a founding member of the Oregon POLST Task Force.
Valerie Jimenez, Executive Director, Oregon POLST Program
Valerie Jimenez is the Executive Director for the Oregon POLST Program, as well as the Oregon POLST Coalition. She also serves as the primary point of contact for all patients, families, and health care professionals interested in more information about the Oregon POLST Program.