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Dying and Death
Published in Lisa Zammit, Georgeanne Schopp, Relational Care, 2022
Lisa Zammit, Georgeanne Schopp
Many people are aware of the terms “full code,” “no code,” and “Do Not Resuscitate (DNR).” There are multiple levels of “codes.” Allow Natural Death (AND) is a relatively new term that is increasing in usage. POLST, originally known as Physician Orders for Life-Sustaining Treatment, is an order set for EOL care. It is based on the Patient’s Advance Directives (AD). Code levels, POLST, and ADs are necessary because of the number of providers involved in Patient care and the need for clear communication.
Artificial Nutrition, Advance Directives and End of Life in Long-Term Care
Published in Victor R. Preedy, Handbook of Nutrition and Diet in Palliative Care, 2019
ADs are considered the written result of advance care planning and must not exist in isolation as simple documents (Figure 14.1, Table 14.3). ADs may be standardized to include certain language, such as those in individual U.S. states, or may be available to the general public. Routinely, ADs contain directions to allow or refuse specific medical treatments. In this manner they may also be called “living wills.” Another form of AD is the power of attorney for healthcare decisions. This AD identifies an individual who will make decisions for the resident should the resident no longer be able to communicate his or her own wishes. These two ADs may also be combined into one document, such as Five Wishes offered by the organization Aging with Dignity. Alternately, 22 U.S. states use some form of the Physician Orders for Life-Sustaining Treatment (POLST), a portable set of medical orders identifying patient preferences (National POLST Paradigm 2016). In some Asian cultures, ADs are viewed as a liberal model for decision-making, one that is not central to normal familiar relationships (Chan 2004), and therefore not utilized as widely (Tsai, Tsai and Liu 2017). For these reasons, much of this section is dedicated to information derived from the United States.
Development of palliative medicine in the United Kingdom and Ireland
Published in Eduardo Bruera, Irene Higginson, Charles F von Gunten, Tatsuya Morita, Textbook of Palliative Medicine and Supportive Care, 2015
Unfortunately, the impact of advance directives on actual resuscitation events remains unclear, with most of the older literature showing minimal effect. Â 22-29 This may be due to several causes. Discussions often do not occur or are not recorded in ways that may have a lasting effect. Â 30 Some of the barriers to successful implementation have been procedural when, for example, documents are not available when needed. More importantly, problems arise with deciding in advance about specific interventions, Â 31 the adequacy of communication, Â 32 the willingness of health-care providers to follow patient preferences, Â 27,30 and patient and family misunderstandings about the process. That said, a recent well-done randomized controlled trial of facilitated advance care planning led to a significantly higher rate of known and followed end-of-life care wishes for intervention group patients, with decreased anxiety, stress, and depression among their family members. Â 33 Furthermore, a new mechanism, often referred to as Physician Orders for Life-Sustaining Treatment (POLST) has been initiated in many U.S. states as a way of ensuring that patient preferences are enacted in practice. Â 34 POLST documents are actual medical orders, respected by emergency medical services and local health-care institutions, which implement a scope of treatment for a particular patient. Initial studies in small well-defined
Injured Older Adults Transported by Emergency Medical Services: One Year Outcomes by POLST Status
Published in Prehospital Emergency Care, 2020
Dana Zive, Craig D. Newgard, Amber Lin, Aaron B. Caughey, Susan Malveau, Elizabeth Eckstrom
Older adults often express preferences for end-of-life goals of care to help ensure that their wishes are followed in situations when they lack decisional capacity. Advance directives, living wills, durable health care powers of attorney, and more recently, Physician Orders for Life Sustaining Treatment (POLST) are legal documents that allow older adults to communicate their goals of care. The POLST is a form signed by a health care professional that specifies end-of-life treatments to guide first responders, emergency physicians, and hospital providers to follow patient goals during life threatening events (1). The POLST form has separate sections indicating specific medical orders for resuscitation or no resuscitation (e.g., if a patient is in cardiac arrest), “Full treatment” (mechanical ventilation, dialysis, intensive care unit admission), “limited additional interventions” (intravenous antibiotics, routine hospital ward care), and “comfort measures” (symptom-based care at home and avoidance of hospital transport when possible) (Supplementary Figure S3).
Too many dying choices
Published in Baylor University Medical Center Proceedings, 2021
This process can be improved, simplified, and lead to more “buy in” from the public. The simplest option is a national acceptance of the Physician Orders for Life-Sustaining Treatment (POLST), which is a solution that currently exists.