MOLST Expands End-of-Life Planning for Physicians, Patients

Too often, palliative care experts say, physicians are unable to carry out their patients end-of life wishes because they were contained in a document that was incomplete, too vague, not legally binding, or simply misplaced by family members.

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.

MOLST differs from the most common type of palliative care planning – advanced directive orders, which usually include a “living will” or other expression of wishes. Those orders generally designate a surrogate decision maker, or health care proxy, to act on behalf of an incapacitated patient.

Living will instructions – when presented by a health care proxy – are generally recognized as evidence of patient preferences, but are not recognized by Massachusetts law.

In contrast, a completed MOLST form travels with the patient at all times, may be faxed or reproduced, and is an official part of a patient’s medical record.  MOLST is more comprehensive than another common end-of-life preference form, the Massachusetts Comfort Care/DNR Verification Protocol, which covers emergency hospital transport and resuscitation efforts.

The MOLST document, which is signed by both patient and physician, encompasses these procedures, as well as breathing tubes and ventilation, artificial nutrition and hydration and dialysis.   Patients or their health care proxy can change MOLST preferences at any time.

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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