MOLST: A New Approach for End-of-Life Care

An estimated 75 percent of patients will be unable to make some of their own medical decisions at the end of their lives. More physicians and clinicians are now finding that advanced directives and living wills are often too vague or unenforceable to ensure optimal care for dying patients.

To ensure patients receive the end-of-life care they desire, Massachusetts is poised to join more than 14 other states with formal Physician Orders for Life-Sustaining Treatment (POLST) programs.

The proposed state protocol, called Massachusetts Medical Orders for Life Sustaining Treatment (MOLST), aims to translate patients’ goals of care into specific medical orders that travel with the patient if he/she changes health care settings.

The MOLST document, signed by both patient and physician, covers specific health care therapies such as CPR, breathing tubes and ventilation, artificial nutrition and hydration, as well as more general patient preferences about issues such as hospital transport. A patient or health care proxy can change MOLST preferences at any time.

Unlike an advanced directive, which often designates a surrogate decision maker and is not part of a patient’s file, a MOLST form travels with the patient at all times and is an official part of a patient’s medical record.

State palliative care experts say they expect MOLST to soon become part of standard patient care for many Massachusetts clinicians. A successful MOLST pilot program in the Worcester area was completed earlier this year and the Executive Office of Health and Human Services is currently evaluating feedback from medical professionals there to shape policy.  The Massachusetts Expert Panel on End-of-Life Care has recommended statewide implementation of MOLST by early 2014.

To learn more about presenting the MOLST option with patients, and how to use MOLST to facilitate conversations about end-of-life care, join us on Dec. 6 for a webinar featuring Dr. Susan Block, co-director of the Harvard Medical School Center for Palliative Care. Visit www.massmed.org/molst for more information.

–          Erica Noonan

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