Oregon POLST Program

December 4, 2019

Oregon POLST Program News
Oregon POLST Coalition Releases New Guidelines on POLST Use in Persons with Significant Disabilities
The Oregon POLST Coalition strives to achieve two goals in creating the Guidelines on POLST Use for Persons with Significant Disabilities who are Now Near the End of Life:   
  • First, to promote broader access to high quality end of life care for persons with significant disabilities who are nearing the end of life.
  • Second, to raise awareness of the appropriate use of POLST and specifically to advise against the use of POLST in those with stable disabilities who do not have a serious illness that is in the advanced stages.
The Coalition thanks Christian Hale, JD and Allison Enriquez-Buehler, JD of the Oregon Department of Human Services for their contributions to the development of these guidelines.
Professional Organizations Endorse Removal of Artificially Administered Nutrition from the Oregon POLST Form
In January of 2019, Oregon made substantive changes to the Oregon POLST form, including removing Section C, artificially administered nutrition.

These changes have been enthusiastically endorsed by healthcare professionals who complete POLST forms, as well as, those who use the information to guide care in a crisis.
The Oregon chapter of the American College of Emergency Physicians (ACEP) and The Oregon Geriatric Society (OGS) have issued statements formally endorsing the removal of the artificially administered nutrition section from the Oregon POLST form.
Should Artificially Administered Nutrition Be Routinely Offered to Those with Advanced Dementia?
In the National Academy of Elder Law Attorneys (NAELA) Journal Volume 15 - 2019 (pp.103-125), Fay Blix and Susan Tolle outline the reasons why offering surgically placed feeding tubes in patients with advanced dementia should not be universally offered.

Through the experience of a family caring for a relative with advanced dementia, the authors share the confusion and distress that can result when the surgical placement of a feeding tube option on a POLST form is offered for an individual with advanced dementia. See pp.116-117.
By presenting surgical placement of feeding tubes as an option, family members may be misled to believe that tube feeding can be helpful in advance dementia when there is no evidence that feeding tubes extend life and insertion is associated with an increase in  complications. (JAGS January 2019).

The article further explains why Oregon removed the section on Artificially Administered Nutrition from the Oregon POLST form in January 2019. For further information, see our Policies and Standards page.
Oregon POLST Registry Celebrates its 10-Year Anniversary
The Oregon POLST Registry enters completed POLST forms and makes those forms rapidly available in a crisis. The Registry is supported by the Oregon Health Authority and operated by contract and through the OHSU Department of Emergency Medicine under the direction of Abby Dotson, PhD.

The Office of the National Coordinator for Health IT describes the Oregon POLST Registry as the most widely used and advanced POLST Registry in the country. Since the Oregon POLST Registry began operation in December of 2009, the Registry has received over 500,000 POLST forms, and the Emergency Communication Center has received over 13,000 calls requesting those POLST forms for patients in a crisis when their POLST was not available at the scene.

The OHSU Center for Ethics does not fund the day-to-day operations of the Registry. The Center is the administrative home of the Oregon POLST Program, which funds the work of the Oregon POLST Coalition, including statewide education, research and innovation that facilitate the POLST Program and the Registry’s success.
Patient Stories Share How POLST Can Help Patients Achieve Their Goals
No single story can fully illustrate the goals of every family; therefore, we add to our growing portfolio of stories on the Patients and Family Resources page, when we can provide insightful offerings. Our newest story, POLST: Choosing FULL TREATMENT When You Hope for More Time, reflects how a patient can use POLST to make decisions based upon their own priorities and values as their health changes.

Patients and their family members often prefer to learn medical information through different methods. POLST: When is the Right Time? is a three-minute video that can be helpful for those who prefer to learn by viewing the stories of others.

We thank the Community Insight Committee for bringing greater strength to the patient’s voice and welcome recommendations for additional stories to add to our portfolio.
Webinar Announcement: January 14, 2020
“POLST: What’s New in Oregon?”
The Oregon POLST Program extends an invitation to join a free webinar. POLST: What’s New in Oregon? will be held on Tuesday, January 14, 2020 at 11:00 AM Pacific Time. Please click here to register.

The Oregon POLST Program is committed to freely sharing our successes and struggles in creating a process that records and honors the treatment goals of those with serious illnesses who are nearing the end of their lives. We request proper attribution of our work that is copied and/or adapted.

During this webinar, we will share Oregon’s new developments in research, quality improvement, educational innovation, local policy development and Registry updates. We look forward to you joining us in the new year!
Anthony Antoville, BFA, CMC
Executive Director, Oregon POLST Program
OHSU - Center for Ethics in Health Care
3181 SW Sam Jackson Park Rd, UHN-86
Portland, OR 97239

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