National POLST Paradigm programsMajority of California healthcare settings recognize POLST as the preferred method of recording treatment preferences for persons with advanced illness or frailty

SNAPSHOTS:

  • California just one of three states recognized as having a “mature” POLST program
  • To achieve “mature” status a state’s POLST program must be implemented and recognized in every region of the state
  • Coalition-building model helped California spread POLST, including passing legislation in a relatively short period of time

California’s program for Physician Orders for Life-Sustaining Treatment (POLST) has received the highest level of recognition from the National POLST Paradigm, which establishes and oversees national standards for POLST.

The National POLST Paradigm announced today that California’s POLST program has achieved Mature status, a level reserved solely for programs in which POLST is implemented in every region of a state, and is used by 50 percent or more hospitals, nursing homes, and hospices. In addition, more than 75 percent of Emergency Medical Services (EMS) must have POLST protocols for a state to achieve Mature status.

In California, the POLST Paradigm program is run by the Coalition for Compassionate Care of California under the direction of CEO Judy Thomas, JD. The Coalition for Compassionate Care of California sponsored the legislation which established POLST in California. AB 3000 (Wolk) was passed unanimously and went into effect in January 2009.

Judy Thomas, JD“We’re excited to join Oregon and West Virginia as the only states recognized as having a Mature POLST program,” said Judy Thomas during an address at the Coalition for Compassionate Care of California 8th Annual Summit.

“Mature status would not be possible without the many volunteers who supported POLST legislation in California, and the grassroots efforts of the 27 local POLST coalitions who worked with us to design and spread the POLST education curriculum now used by many POLST programs around the country.”

POLST is a medical order signed by both a patient and physician, nurse practitioner or physician assistant that specifies the types of medical treatment a patient wishes to receive toward the end of life. POLST is also a tool that encourages conversation between providers and patients about their end-of-life treatment options, and helps patients make more informed decisions and communicate their wishes clearly. As a result, POLST can prevent unwanted treatment, reduce patient and family suffering, and help ensure patient wishes are followed.

“The Coalition for Compassionate Care of California was successful at implementing POLST because they built a strong implementation model by forming coalitions comprised of stakeholders representing a diverse array of interests,” said Amy Vandenbroucke, executive director of the National POLST Paradigm. “We are pleased to recognize California’s POLST program, particularly since Judy Thomas has been so willing to mentor other developing states by sharing the California model.”

In 2015, the Coalition for Compassionate Care of California sponsored two POLST-related bills and both were signed by Governor Jerry Brown. AB 637 (Campos) allows nurse practitioners and physician assistants – under the supervision of a physician and within their scope of practice – to sign POLST forms and make them actionable medical orders. SB 19 (Wolk) requires the State to establish and operate a statewide digital registry for the purpose of collecting POLST forms received from health care providers.

“Compared with the rest of the country, Judy Thomas and the Coalition for Compassionate Care of California championed POLST legislation in a relatively short period of time by being able to get the nation’s most populous, diverse and arguably most complicated state to pull in one direction,” said Susan Tolle, MD, professor of medicine at the Center for Ethics in Healthcare at the Oregon Health & Science University. Tolle is also a founding member of the Oregon and National POLST task forces. “The Coalition’s ability to bring people together, form consensus, and develop models for education and training are on the leading edge.”

Currently, there are 47 states throughout the country which have received some level of formal acknowledgement from the National POLST Paradigm.


About the Coalition for Compassionate Care of California
The Coalition for Compassionate Care of California (CCCC) is an interdisciplinary partnership of thought-leaders from healthcare systems and organizations, government agencies, consumer organizations, and individuals working together to promote high-quality, compassionate palliative and end-of-life care for all Californians. Since 1998, CCCC has been working to transform healthcare so that medical care is aligned with individual patient preferences—that people get the care they need and no less, and the care they want and no more. Through advocacy, education, and resource development, CCCC is working to ensure that organizations and communities have the information, knowledge and tools to increase access to advance care planning and palliative care.

About the National POLST Paradigm
The National POLST Paradigm is an approach to end-of-life planning based on conversations between health care professionals and patients; the patient discusses his or her values, beliefs, and goals for care, and the health care professional presents the patient’s diagnosis, prognosis, and treatment alternatives. Together they reach a shared decision about the patient’s treatment plan that is informed and based on the patient’s values, beliefs and goals for care.

The National POLST Paradigm began in Oregon in 1991 by health care professionals who recognized that patient preferences for end-of-life treatment were not being consistently honored during emergencies. Over the past 20+ years the Paradigm has expanded to 47 states.

2 Responses to “National task force recognizes California for “mature” POLST program”

  1. Elizabeth Richell

    If a POLST is different from an Advanced Health Care Directive, please tell me how to print this form. If it’s the same, I don’t need one, as I have a completed, signed and witnessed AHCD. Many thanks.

    Reply
    • Elizabeth,
      POLST and advance directives are similar, but there are key differences.
      An Advance Directive is used to provide guidance regarding future treatment wishes and to appoint a legal healthcare decisionmaker – someone authorized by you to speak on your behalf if you no longer can speak for yourself. An Advance Directive is recommended for all adults, regardless of their health status because an accident or sudden health crisis can happen to anyone.
      A POLST is designed for people who are seriously ill or within the last year or so of life. It is based on a patient’s current health status, so it may not be appropriate for people who have a longer life expectancy because treatment wishes and goals for care can change significantly over time, based on personal life goals, age, overall health and long-term prognosis.
      If you are relatively healthy, you probably only need an advance directive. If you have a serious health condition, you may want to have both: an advance directive to designate a medical decisionmaker and a POLST to clearly outline your treatment wishes. If you do choose to have both a POLST and advance directive, make sure that your treatment wishes are aligned in both documents to avoid any confusion regarding treatment.
      – Kelley

      Reply

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