NHPCO NewsLine Fall 2021 - 35

Coalition and I remember the leader complaining
that medical students coming from other states, like
New York that used the term " MOLST " , did not
recognize Oregon's POLST form as the same
document or know how to use it. Despite their
having been trained about MOLST, they were not
aware different states had different versions of the
form. Over the years I can attest that this is not a
unique complaint.
The goal should be subtracting anything that
creates a barrier to POLST portability and simplicity:
rather than adding new laws or regulations that add
complexity, fail to address the root cause of
portability, and that may give the deficient current
situation some credibility, resources should be
focused on subtracting variation and simplifying to
a single form.
As Hans Hofman stated, " the ability to simplify
means to eliminate the unnecessary so that the
necessary may speak. " The necessary is the patient
expressing their autonomy by using the POLST form
to state what treatments they want to receive
towards the end of their life. The value of POLST
orders cannot be understated for the patient who
has them: these orders can make the difference of
dying comfortably in their own home or dying in a
hospital after going through the brutality of
resuscitation.
There are so many possibilities as more states adopt
or adapt the national form, including:
▌ Patient (and caregiver!) happiness. It would make
all the patients calling National POLST happy to
hear that their current POLST is all they need,
regardless of where they are traveling in the US.
(It would make me happy too.)
▌ Health care professional happiness. I would
assume that if their patients are happy, health
care professionals are happy. Further, health care
professionals could become more comfortable
with the POLST process, the form and be able to
easily advise their traveling patients.
▌ Education. National education in medical schools,
conferences, CMEs about how to recognize, use
and honor POLST forms and how they differ from
advance directives becomes easy.
▌ Research & quality improvement. Any creation
and subsequent revision of a POLST form should
be informed by robust data. Since a larger data
set has a better chance of meaningfully improving
POLST, a single national form creates an
opportunity to nationally conduct research and
quality assurance activities, creating shared data
for generalizable knowledge that can identify and
answer outstanding questions, and evaluate
rationale for all POLST form elements. Quality
assurance activities can be more easily created,
and results pooled. This data could inform
improvements to the POLST form and process,
strengthening POLST overall.
NOTHING WORTH DOING IS EASY:
THE REWARD IS WORTH THE EFFORT
Letting go or subtracting is not easy. A few years ago,
leadership reconsidered the POLST acronym. By this
time, the name " physician orders for life-sustaining
treatment " had existed for over 15 years. The leaders
immediately agreed the name was inaccurate: it gave
the wrong impression that only physicians can sign
(lamentably still true in a few states) and that the
form was focused on " life-sustaining treatments "
when the goal-from the start-is about honoring
treatment wishes from life-sustaining through
allowing natural death. Despite this agreement, it
took a couple of years of discussion about how to
proceed. As you would expect, trying to work within
the confines of keeping the acronym " POLST " (which
was recognizable), many of the solutions were wordy
or cumbersome. In the end, however, subtracting the
outdated and incorrect name and simplifying POLST
to be a term, rather than an acronym, allowed
National POLST to better highlight the purpose of
the form: it is a " portable medical order " . It is still a
challenge to educate about this, but it feels better to
speak more positively about what POLST is as
opposed to apologizing or defending an inaccurate
name or description.
Newsline / Fall 2021 35
NHPCO NewsLine Fall 2021

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