The GeriPal Podcast recently featured a lively discussion on POLST, with guests Kelly Vranas, MD, Abby Dotson, PhD, Karl Steinberg, MD, and Scott Halpern, MD. "POLST Evidence and Update" focused on the debate surrounding the evidence base for POLST and whether the current evidence—or lack of robust evidence—should have an impact on the use of POLST in those with serious illness. Although there was disagreement about the evidence regarding the utility of POLST for ensuring goal-concordant care, all agreed on one key point: having quality conversations with seriously ill patients is always of value. Listen/watch here.
Large Study Focuses on POLST Use in Nursing Home Residents
A recent Journal of General Internal Medicine article by Zingmond et al. examined the relationship between POLST documentation and hospital utilization among nursing home residents. Through a massive retrospective cohort study using data on more than 1 million nursing home residents in California between 2011 and 2016, the researchers looked at the relationship between care choices documented via POLST and hospitalizations/ICU admissions. Results of the analysis indicated that residents who had documented DNR–comfort care on a POLST spent 56 fewer days in the hospital and 22 fewer days in the ICU per hundred person years than residents who did not have a valid POLST completed.
The authors concluded, "POLST is a reliable mechanism of translating care decisions into medical treatment across treatment settings." Of note is that 11% of the POLST forms on file were unsigned, and therefore not valid. This highlights the need to ensure that staff are educated on proper POLST use and that processes are in place to ensure that protocols for POLST completion are followed. Read the open-access article at here.
POLST Legislation Update
In the last issue, we shared about the two POLST bills that were introduced in the Pennsylvania House and Senate this term. There has been no movement on these bills since spring. On April 28, SB631 was referred to the Senate Health and Human Services Committee. On May 19, HB1212 was referred to the Health Committee in the House. We will keep you updated on any progress on this important legislation, and you can check the status and sign up for updates here.
Advocates Delivered ACP/POLST Education to Professional Audiences
Advocates for POLST and advance care planning delivered educational presentations to a range of professional audiences this summer and fall.
Judith Black, MD, MHA, gave several POLST presentations in Western Pennsylvania this year. On June 2, Dr. Black and Libby Moore, PhD, presented a three-hour course through the University of Pittsburgh Consortium Ethics Program at La Roche University. On June 13, Dr. Black presented POLST: Doing It Right! to staff of the Highmark Enhanced Community Care Management program at their Downtown Pittsburgh offices, with additional staff participating virtually. On September 20, Dr. Black presented virtually to staff at Meadville Medical Center, and on November 16, she presented virtually to family medicine residents at UPMC St. Margaret.
Grace Orsatti, JD, presented on end-of-life issues, including POLST, during a Pennsylvania Bar Institute continuing education symposium on November 7.
Alexander Nesbitt, MD, presented "Navigating End-of-Life Conversations: Legal, Medical, and other Considerations" during a continuing education symposium for the Pennsylvania Bar Institute's Estate Law Institute on November 14.
Interested in POLST training for your organization or facility? Contact info@papolst.org to learn about options for virtual and in-person trainings.
Check out the POLST Learning Center for Free On-Demand Education
The POLST Learning Center offers 10 self-paced online continuing education modules, providing a total of 11 CME/CNE credits at no cost! Gain the skills you need to have quality end-of-life conversations and to implement a successful POLST program. Topics include fundamentals of POLST and advance directives, tools and strategies for having POLST conversations, POLST implementation, Medicare reimbursement, cultural humility, pediatrics, and EMS.
Special thanks to the Pennsylvania Bureau of Emergency Medical Services for including the POLST training in its online education portal. To date, more than 3,700 EMS providers have completed POLST education via PA TRAIN!
Death and Dying Fellowship Now Recruiting for Winter 2024 Cohort
The Jewish Healthcare Foundation is recruiting current or recent graduate students to participate in the 2024 Death and Dying Fellowship. Now in its 10th year, the fellowship is designed to improve participants’ comfort around the topics of serious illness and communication around death and grief with patients and their families.
Applications are due by December 14, and the program begins January 22 with a combination of virtual sessions and in-person sessions/site visits in Pittsburgh. Please share this with any current/recent students who may be interested. More information is available here.
