Most people would choose to die at home surrounded by loved ones rather than in a hospital — but that is not always the way it works out.
As a physician involved in hospice care, I was not surprised to read that a recent study published in JAMA Internal Medicine suggests that although many have thought about end-of-life care and discussed it with family members, few have spoken with doctors or have had their wishes noted correctly in their medical records.
Dr. Daren Heylan of Kingston General Hospital in Ontario, Calif., said such lack of discussion about patients' wishes often leads to painful, extremely aggressive care at the end of life, followed by stress and regret from family members. Too often patients have not voiced whether they would prefer to forgo being hospitalized as their diseases progressed, so they could instead remain at home receiving palliative (comfort) care.
I was quite taken aback to find, however, that even when end-of-life wishes were noted in the medical records, two out of three times those notes differed from what patients and family members expressed during the interviews. Are the doctors unable to understand the wishes the patients and families told them about? Surely the doctors were trying to follow each patient's instructions? Were they unclear?
Does your family know your wishes or, more important, will they be able to explain to your doctor what kinds of care you would or would not want?
As medical director of Suncoast Hospice, I am proud to share with our community that we are taking steps to address this issue. We are the first hospice in Florida to begin a pilot program using the Physician Orders for Life Sustaining Treatment (POLST) form. The POLST model is an approach to end-of-life planning based on conversations among patients, loved ones and medical providers. POLST is designed to ensure that seriously ill patients can choose the treatments they want and their decisions will remain firm.
The POLST program is best practice for ensuring that end-of-life treatment preferences are honored. POLST provides a method for transferring your treatment preferences into specific medical orders that are recognized in all health care settings (hospital, home care, long-term care and during transport).
A key component of the system is thoughtful conversation between you and your health care professionals to determine the treatments you do and do not want based on your personal beliefs and current state of health. In these conversations, you will be informed of treatment choices and, if you wish, your health care professional will complete a POLST form based on your expressed treatment preferences.
Meant to supplement, not replace, traditional advance directives for patients expected to die within a year, POLST has several advantages:
• First, it is a medical order signed by the health care provider.
• Second, since POLST is a single-page standardized form, it is easy to follow.
• Third, unlike DNR (do-not-resuscitate) orders, POLST addresses not just resuscitation, but an entire range of life-sustaining interventions, such as intravenous fluids, antibiotics, a feeding tube and artificial breathing.
• Fourth, POLST is transportable. It is a brightly colored, clearly identifiable form that remains in the patient's chart and travels with the patient from hospital, to nursing home, to ambulance, to the patient's home. POLST is recognized and honored across all these different treatment settings.
Suncoast Hospice will introduce the POLST form in our agency in coming months, and there is a statewide effort to gain acceptance of its use throughout Florida. To view a draft version of the Florida POLST form, visit www.med.fsu.edu/medlaw/POLST. Or call Project GRACE at 727-536-7364.
If you wish to die at home in familiar surroundings with loved ones at your side, the POLST form can help you achieve your goals.
Dr. Deidra R. Woods is the medical director of Suncoast Hospice. She wrote this exclusively for the Tampa Bay Times.