Brochures

These brochures provide patients and families with a broad, general overview of Oregon’s POLST program.


Educational Tools

The Oregon POLST Task Force Education Committee created standardized presentations to be used to educate about POLST with specific audiences.  If you or your facility is interested in using the Oregon POLST presentations with patients, please contact the Oregon POLST Program Office (polst@ohsu.edu) for the PowerPoint version, including faculty notes. 


Publications

Moss AH, Zive DM, Falkenstine EC, Dunithan C. (2017). The Quality of POLST Completion to Guide Treatment: A 2-State Study.  Journal of the American Medical Directors Association, available online 28 June 2017. doi: 10.1016/j.jamda.2017.05.015. 

Lammers A, Zive DM, Tolle SW, Fromme EK. (2017). The Oncology Specialist’s Role in POLST Form Completion. American Journal of Hospice and Palliative Medicine, available online 16 April 2017. doi:10.1177/1049909117702873.

Tolle SW, Teno JM. (2017). Lessons from Oregon in Embracing Complexity in End-of-Life Care. New England Journal of Medicine, available online 16 March 2017; 376:1078-1082. doi: 10.1056/NEJMsb1612511

Hayes SA, Zive D, Ferrell B, Tolle SW. (2016). The Role of Advanced Practice Registered Nurses in the Completion of Physician Orders for Life-Sustaining Treatment. Journal of Palliative Medicine, available online 21 October 2016. doi:10.1089/jpm.2016.0228.

Zive DM, Cook J, Yang C, Sibell D, Tolle SW, Lieberman M. (2016). Implementation of a Novel Electronic Health Record-Embedded Physician Orders for Life-Sustaining Treatment System. Journal of Medical Systems, available online 1 October 2016, 40: 245. doi:10.1007/s10916-016-0605-3

Zive DM, Fromme EK, Schmidt TA, Cook JNB, Tolle SW. (2015). Timing of POLST Form Completion by Cause of Death. Journal of Pain and Symptom Management, available online 7 July 2015, ISSN 0885-3924, http://dx.doi.org/10.1016/j.jpainsymman.2015.06.004. 

Fromme EK, Zive D, Schmidt TA, Cook JNB, Tolle SW. (2014). Association Between Physician Orders for Life-Sustaining Treatment for Scope of Treatment and In-Hospital Death in Oregon. Journal of the American Geriatrics Society, doi: 10.1111/jgs.12889.

Schmidt TA,  Olszewski Hunt EA, Zive D, Fromme EK, Tolle, SW. (2014). In Response to Letter to the EditorThe Journal of Emergency Medicine, ISSN 0736-4679, http://dx.doi.org/10.1016/j.jemermed.2014.07.057.

Schmidt TA, Zive D, Fromme EK, Cook JNB, Tolle SW. (2013). Physician Orders for Life-Sustaining Treatment (POLST): Lessons learned from analysis of the Oregon POLST RegistryResuscitation, available online 6 January 2014, ISSN 0300-9572, http://dx.doi.org/10.1016/j.resuscitation.2013.11.027. 

Richardson DK, Fromme EK, Zive D, Fu R, Newgard CD. (2013). Concordance of Out-of-Hospital and Emergency Department Cardiac Arrest Resuscitation With Documented End-of-Life Choices in Oregon. American College of Emergency Physicians, 2013 Nov 6.pii: S0196-0644(13)01345-0. doi: 10.1016/j.annemergmed.2013.09.00. 

Schmidt TA, Olszewski EA, Zive D, Fromme EK, Tolle SW. (2013). The Oregon POLST Registry: A Preliminary Study of Emergency Medical Services Utilization. The Journal of Emergency Medicine, Volume 44, Issue 4, April 2013, Pages 796-805, ISSN 0736-4679, 10.1016/j.jemermed.2012.07.081. 

Olszewski EA, Newgard CD, Zive D, Schmidt TA, McConnell KJ. (2012). Validation of Physician Orders for Life-Sustaining Treatment: Electronic Registry to Guide Emergency Care. Journal of the American Geriatrics Society, 2012 Jul; 60(7):1384-6. doi: 10.1111/j.1532-5415.2012.04027.x. 

Fromme EK, Zive D, Schmidt TA, Olszewski EA, Tolle SW. (2012) POLST Registry Do-Not-Resuscitate Orders and Other Patient Treatment PreferencesThe Journal of the American Medical Association, 2012;307(1):34-35. doi:10.1001/jama.2011.1956. 

Hickman SE, Nelson CA, Moss AH, Tolle SW, Perrin NA, Hammes BJ. (2011). The Consistency between treatment provided to nursing facility residents and orders on the physician orders for life-sustaining treatment form. Journal of the American Geriatrics Society, 59(11):2091-2099.

Hickman SE, Nelson CA, Perrin NA, Moss AH, Hammes BJ, Tolle SW. (2010). A comparison of methods to communicate treatment preferences in nursing facilities: Traditional practices versus the physician orders for life-sustaining treatment program. Journal of the American Geriatrics Society, 58(7):1241-1248.

Hickman SE, Nelson CA, Moss AH, Hammes BJ, Terwilliger A, Jackson A, Tolle SW. (2009). Use of the Physician Orders for Life-Sustaining Treatment (POLST) paradigm program in the hospice setting. Journal of Palliative Medicine. 12(2):133-41.  The POLST (Physician Orders for Life-Sustaining Treatment) is a medical order form designed to ensure that the full range of patient treatment preferences are honored throughout the healthcare system. However, data are lacking to evaluate the utility of the POLST in the hospice setting. A pilot study was conducted to evaluate the use of the POLST in hospices in three states: Oregon, Wisconsin, and West Virginia (where it is known as the Physician Orders for Scope of Treatment or POST). A telephone survey found that the POLST is used widely in hospices in Oregon (100%) and West Virginia (85%) but only regionally in Wisconsin (6%). Respondents at POLST using hospices (n = 71) were asked about their attitudes towards the POLST. Most (97%) believed the POLST form was useful in preventing unwanted resuscitations by emergency medicine personnel and a similarly large number (96%) found the POLST form useful in initiating conversations about treatment preferences. Reviews of randomly selected charts (n = 373) were conducted at a convenience subsample of POLST-using programs in Oregon (8), West Virginia (5) and Wisconsin (3). Most charts reviewed (74%) contained a POLST form. A majority (96%) of POLST forms contained do-not-resuscitate (DNR) orders. Of those with DNR orders, 78% wanted more than the lowest level of treatment in at least one other treatment category, such as an antibiotic or hospitalization. Preferences for treatment limitations were respected in 98% of cases and no one received unwanted CPR, intubation, intensive care, or feeding tubes. Findings suggest that the POLST is well regarded by hospice staff and allows for greater individualization of care plans than traditional approaches focused on code status. In the hospice population, DNR does not equal “do not treat.”

Hickman SE, Sabatino CP, Moss AH, Nester Wehrle J. (2008). The POLST (Physician Orders for Life-Sustaining Treatment) Paradigm to Improve End-of-Life Care: Potential State Legal Barriers to Implementation. Journal of Law, Medicine & Ethics, 36: 119–140.  The tables in this manuscript contain a state by state review of each states surrogate laws, advance directives statutes and out of hospital DNR orders. State specific potential legal and regulatory barriers to the implementation of a POLST Paradigm program are identified.

Hickman SE, Hammes BJ, Moss AH, Tolle SW. (2005). Hope for the Future: Achieving the Original Intent of Advance Directives. Improving End of Life Care: Why Has It Been So Difficult? Hastings Center Report Special Report, 35(6):S26-S30.

Hickman SE, Tolle SW, Brummel-Smith K, Carley MM. (2004). Use of the physician orders for life-sustaining treatment program in Oregon nursing facilities: Beyond resuscitation status. Journal of the American Geriatrics Society, 52(9):1424-1429.  All licensed nursing facilities in the state of Oregon (n = 151) were surveyed in 2002 to assess use of the POLST Program. The majority (97%) of all facilities participated (3% could not be reached). Of those surveyed, most (71%) reported that they used the POLST form for at least half of their residents and 96% who used the POLST reported that it is used to guide treatment decisions in the facility. Permission was obtained to conduct on-site reviews of records at a subsample of 7 facilities identified as users of the POLST Program. POLST forms were present in 92% (429/467) of medical charts reviewed. Treatment orders for adults ages 65+ (n = 397) included do not resuscitate (DNR: 88%), comfort care or limited interventions (88%), no or limited antibiotic use (42%), and no or limited artificial nutrition/hydration (87%). On forms indicating DNR, 77% reflected preferences for more than the lowest level of treatment in at least one other category. On POLST forms indicating orders to resuscitate, 47% reflected preferences for less than the highest level of treatment in at least one other category. The oldest old (aged 85 and up, n = 167) were more likely than the young old (aged 65-74, n = 48) to have orders to limit resuscitation, medical treatment, and artificial nutrition and hydration. Although optional, the majority (71%) of forms were signed by a resident or surrogate.

Schmidt TA, Hickman SE, Tolle SW, Brooks HS. (2004). The physician orders for life-sustaining treatment program: Oregon emergency medical technicians’ practical experiences and attitudes. Journal of the American Geriatrics Society, 52(9):1430-1434.  In order to better understand the use of the POLST Program, a mail survey was conducted of a random sample of Emergency Medical Technicians (EMTs) with a 55% (572/1050) response rate. Most respondents (72%) had treated at least one patient with a POLST. The majority of patients (71%) with POLST forms were found in long-term care settings. In 45% of cases where a POLST was present, EMTs reported that it changed treatment. Most (74%) of the respondents agreed that the POLST Program provides clear instructions about patient’s preferences and 91% agreed that the POLST Program is useful in determining which treatments to provide when the patient has no pulse and is apneic. Fewer (62%) agreed that the program is useful in determining treatments when the patient has a pulse and is breathing. Findings suggest that EMTs find the POLST Program useful in making treatment decisions for seriously ill patients and often use the form, when present, to change treatment decisions.

Lee MA, Brummel-Smith K, Meyer J, Drew N, London MR (2000). Physician Orders for Life-Sustaining Treatment (POLST): Outcomes in a PACE Program. Journal of the American Geriatrics Society, 48, 1219-1225.  A second, retrospective study evaluated the records for the last two weeks of life for enrollees in an Oregon PACE (Program of All-Inclusive Care for the Elderly) site, a program that cares for frail older adults who meet the criteria for nursing facility placement but are maintained at home. It was found that care matched POLST instructions regarding CPR for 91% of participants, antibiotics for 86%, intravenous fluids for 84%, feeding tubes for 94%, and medical interventions for 46%, with more invasive medical interventions given to 20% of participants.

Tolle SW, Tilden VP. (2002). Changing End-of-Life Planning: The Oregon Experience. Journal of Palliative Medicine, 5(2):311-317.

Tolle SW, Tilden VP, Nelson CA, Dunn PM. (1998). A prospective study of the efficacy of the physician order form for life-sustaining treatment. Journal of the American Geriatrics Society, 46(9):1097-1102.  A sample of n = 180 resident charts at 8 nursing facilities in Oregon were reviewed prospectively over a one-year period. Only the residents whose charts contained POLST forms documenting "do not resuscitate" and "comfort measure only" orders were followed. No participants received unwanted cardiopulmonary resuscitation, intensive care unit care, or ventilator support during the course of the study. Approximately one third had an order for narcotics and a majority (63%) of the residents who died had either PRN or scheduled orders for narcotics. The POLST form orders were consistently followed at this select sample of facilities.

Dunn PM, Schmidt TA, Carley MM, Donius M, Weinstein MA, Dull VT. (1996). A method to communicate patient preferences about medically indicated life-sustaining treatment in the out-of-hospital settingJournal of the American Geriatrics Society, 1996 Jul;44(7):785-791. Focus groups were conducted with health care professionals in Oregon to facilitate the development of the Medical Treatment Coversheet (MTC), the precursor to the POLST form. Next, acute and long-term care providers were provided with hypothetical scenarios and asked to describe their treatment response to each scenario twice: Once without the MTC and once with the MTC. Use of the MTC changed treatment decisions in hypothetical scenarios for 37% of acute care providers and 29% of long-term care providers. The majority of treatment decisions were more appropriate (consistent with patient preferences) with use of the MTC.


Videos

Understanding POLST

Videos are best viewed in Google's Chrome browser.

The Oregon POLST Program’s “Understanding POLST” video provides a clear, detailed overview of the Oregon POLST Program and Form using language that individuals without a health care background can understand. The video explains the purpose of POLST and then describes each section of a POLST form.   


Understanding POLST (Spanish)

The Oregon POLST Program’s “Understanding POLST” video in Spanish provides a clear, detailed overview of the Oregon POLST Program and Form using language that individuals without a health care background can understand. The video explains the purpose of POLST and then describes each section of a POLST form.


Quitarles a sus seres queridos un peso de encima con el formulario POLST 

"Taking a burden off your loved ones with the POLST Form" is an educational tool for Spanish speaking patients. After being diagnosed with cancer, Gladys shares her experience with using the Physician's Orders for Life-Sustaining Treatment (POLST) to choose some treatments and refuse others.


POLST: Doing It Better

This video is an educational tool that describes POLST, clarifies which individuals POLST should be offered to, emphasizes best practices for POLST and corrects some common misconceptions.


POLST: When Advance Directives Are Not Enough

This video tells the story of Max and his family. When Max was confronted with difficult decisions about the care he wanted in the face of his advancing illness, he took comfort in the fact that his wish for a peaceful, natural death was clearly documented in an Advance Directive. Tragically, Max and his loving family discovered that the Advance Directive did not ensure that these wishes would be honored at a time of medical crisis. The video demonstrates the importance of POLST programs in these situations.


POLST: What's New and How Can We Do Better

This is a webinar presented by the Patient Centered Primary Care Institute on 3/18/15. Dr.
Tolle presented along with Joyce Hollander-Rodriguez, Gary Plant, and Lyle Flannigan on use of
POLST in Primary Care.


Dr. Susan Tolle explains the POLST Program

In this video, Dr. Susan Tolle, Director of the Center for Ethics in Health Care at Oregon Health & Science University, provides an overview of the Oregon POLST Program and discusses who can benefit from the POLST Program.