Integrating POLST into palliative care guidelines: a paradigm shift in advance care planning in oncology.

Title

Integrating POLST into palliative care guidelines: a paradigm shift in advance care planning in oncology.

Creator

Bomba Patricia A; Vermilyea D

Publisher

Journal Of The National Comprehensive Cancer Network

Date

2006

Subject

Humans; decision making; advance care planning; DNAR; Palliative Care; Medical Oncology; Advance Directives; Neoplasms/px [Psychology]; Neoplasms/th [Therapy]; Physician's Practice Patterns/og [Organization & Administration]; Life Support Care/st [Standards]

Description

Because predicting and outlining guidance for all possible scenarios is difficult, advance directives are rarely sufficiently precise to dictate patient preferences in specific situations as a disease progresses. Nonetheless, advance care planning is an essential process that should begin at the time of diagnosis, if not already initiated, to ensure that all patient and family rights are preserved. Communicating effectively with the patient and family and having the patient designate a surrogate decision-maker are critical. Attention must be paid to resolving conflicts among patient values and preferences and those of family and the health care team. Patient-centered goals for care and expectations should be elicited at first assessment and reassessed frequently as conditions change. As a disease progresses, advance directives are rarely precise enough to predict all possible scenarios and outline guidance for care. Therefore, for patients with advanced metastatic cancer and a potential life expectancy of less than 1 year, converting patient-centered treatment goals into actionable medical orders while the patient maintains capacity is a more effective way to ensure that patient preferences are honored. Physician Orders for Life-Sustaining Treatment (POLST) and similar medical order forms provide explicit direction about resuscitation status ("code status") if the patient is pulseless and apneic. POLST also includes directions about additional interventions the patient may or may not want. A decade of research in Oregon has proved that the POLST Paradigm Program more accurately conveys end-of-life preferences that are more likely to be followed by medical professionals than traditional advance directives alone.
2006

Rights

Article information provided for research and reference use only. PedPalASCNET does not hold any rights over the resource listed here. All rights are retained by the journal listed under publisher and/or the creator(s).

Type

Journal Article

Citation List Month

Backlog

Pages

819-29

Issue

8

Volume

4

Citation

Bomba Patricia A; Vermilyea D, “Integrating POLST into palliative care guidelines: a paradigm shift in advance care planning in oncology.,” Pediatric Palliative Care Library, accessed December 1, 2021, https://pedpalascnetlibrary.omeka.net/items/show/13251.

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