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Victory and Retreat
Published in Robert S. Holzman, Anesthesia and the Classics, 2022
A recent legislative advance that enhances and even emboldens this discussion with patients is Medical Orders for Life-Sustaining Treatment (MOLST). A MOLST is a form that contains directions about CPR and other life-sustaining treatments (which anesthesiologists are often involved with) specific to a patient’s current condition. Because it is a medical order, it must be signed and dated by a licensed state medical provider. This is different than an Advance Directive, which can contain a living will, organ donation requests, plans to donate one’s body to science and the appointment of an agent to make health decisions if one becomes unconscious. For the MOLST statute to achieve its goal, physicians must be willing to discuss end of life decisions with their patients. In doing so, they must admit to their patients and to themselves that they may not be able to save their patients’ lives.
Key Role of Social Work in Effective Communication and Conflict Resolution Process
Published in Mary Beth Morrissey, Bruce Jennings, Partners in Palliative Care, 2013
Patricia A. Bomba, Mary Beth Morrissey, David C. Leven
In the absence of surrogate decision making laws in New York State prior to the FHCDA, this innovative two-step approach to advance care planning was successful in increasing completion rates for health care proxies across upstate New York and also in development and implementation of the MOLST program. The two-step approach to advance care planning encourages all persons 18 years of age and older to complete a health care proxy while they are healthy and to update this advance directive across the health-illness continuum from wellness until end of life. Seriously ill individuals with advanced chronic illness who may die in the next year and those interested in further defining their wishes are encouraged to have more intensive conversations on goals of care as part of the MOLST program. The two evidence-based programs include: Community Conversations on Compassionate Care (CCCC), an awardwinning, nationally recognized program developed to help individuals over 18 years of age complete health care proxies. The CCCC program focuses on “Five Easy Steps” to complete a health care proxy, as outlined in the CCCC Advance Care Planning booklet, the “Five Easy Steps” webpage the community web designed by the Initiative, and the CCCC videos (Community Conversations on Compassionate Care Advance Care Planning booklet. 2010; Community Conversations on Compassionate Care “Five Easy Steps, 2007; Community Conversations on Compassionate Care Videos. 2007).Medical Orders for Life-Sustaining Treatment (MOLST), a program designed to improve the quality of care people receive at the end of life based on effective communication of patient wishes, documentation of medical orders on a brightly colored pink form, and a promise by health care professionals to honor these wishes.
Pediatric Palliative Care
Published in Hospital Practice, 2021
Benjamin Moresco, Dominic Moore
Advance care planning (ACP) is a core specialty of PPC [36]. For some AYA patients with capacity, this may be in the form of an Advance Directive with a named surrogate decision-maker. Most PPC patients fall into the age or functional status that a formal Advance Directive is not an option. In these cases, PPC teams may engage children with tools such as ‘Voicing My Choices’ or ‘5 Wishes’ that provide a context for talking about what is most important to them with those who will be making decisions on their behalf [91]. Plans made by families and prescribers for how emergency care should be provided outside of the hospital can be formalized through a Provider Order for Life Sustaining Therapy (POLST). In some areas of the United States, these orders may be referred to as Medical Orders for Life-Sustaining Treatment (MOLST) or Physician Orders for Scope of Treatment (POST). Families can choose to provide this document to emergency medical providers who respond to distress. Some families make a choice for this order to be filled in with the least interventional, most comfort-oriented plan because they know that they have the ability to escalate the intensity of care provided but will not have the ability to de-escalate care without an order signed by a prescriber.
Decision-Making in the Moments Before Death: Challenges in Prehospital Care
Published in Prehospital Emergency Care, 2019
Deborah P. Waldrop, Jacqueline M. McGinley, Michael W. Dailey, Brian Clemency
Varying state laws limit the ability of EMS personnel to base treatment decisions on direction from surrogate decision-makers, advance directives; and even written medical orders. In New York State, where this study took place, medical orders can be entered on a nonhospital Do Not Resuscitate (DNR) order or on Medical Orders for Life Sustaining Treatment (POLST/MOLST) form. The law does not expand the ability of EMS personnel to honor other advance directives, such as a Health Care Proxy or Living Will (7, p. 4). Physician or Medical Orders for Life Sustaining Treatment (POLST/MOLST) were developed to provide a means for people with serious illnesses to inform providers about specific treatment preferences when they are unable to articulate their own wishes (8). Misunderstanding the difference between POLST/MOLST and other types of advance directives has been identified as a problem nationwide (9, 10).
Strengthening advance care planning in rural residential aged care through multidisciplinary educational case conferences: A hybrid implementation-effectiveness study
Published in Progress in Palliative Care, 2021
Suzanne Rainsford, Sally Hall Dykgraaf, Rosny Kasim, Christine Phillips, Nicholas Glasgow
Review of decedent records: Facility health record review was performed by SR for all residents who died between January and June 2019. Data extracted included: cause and location of death, and documented evidence of anticipatory medications and ACP (a formal advance care directive, medical orders for life sustaining treatment (MOLST),26 or any informal goals of care statement written in the health records by the GP).