Oregon’s groundbreaking Physician Orders for Life Sustaining Treatment program (POLST) is featured in the latest edition of the Journal of The American Medical Association. The program, which was created by health care professionals two decades ago in an effort to ensure the wishes of those with advanced illness are followed, has now spread to 34 states around the country.
READ – POLST Registry Do-Not-Resuscitate Orders and Other Patient Treatment Preferences (excerpt)
The program’s key component is an order form that provides clear instruction about the patient’s health care preferences to health professionals, such as paramedics and emergency room physicians, when a patient cannot communicate these wishes themselves. The form allows patients to request that they receive or refrain from certain measures such as CPR or intensive care. In addition, Oregon’s program includes a registry that offers 24-hour access to emergency workers when the printed form cannot be located.
The JAMA article highlights the latest research to gauge the impacts of the program. That data revealed:
- 25,142 people were enrolled in Oregon’s registry during the first year of operation.
- 86 percent of patients in the POLST program are 65 or older.
- 28 percent wished to receive CPR if needed.
- 72 percent had a “Do Not Resuscitate” order.
- 50 percent of patients who had a DNR order wanted to be hospitalized.
“Our study shows that resuscitation is not the most important question for people with advanced illness and frailty,” said Susan Tolle, M.D., director of the Center for Ethics in Health Care at Oregon Health & Science University and senior author on the study. OHSU administers both the program and the registry. “Not only is CPR unlikely to be successful in patients with advanced illness, but knowing that the patient has a DNR order does not predict what other treatments they want or do not want. Half of patients with a DNR order wanted to return to the hospital and half did not. POLST orders for scope of treatment clarify which patients want to be hospitalized and whether they would want intensive care in a time of crisis.”
“The POLST program creates a system that has been shown to have advantages over traditional advance directives and do-not-resuscitate orders by providing a more comprehensive set of medical orders based on patient preferences and ensuring that patients receive the medical treatment they want with a high degree of accuracy,” added Alvin H. Moss, M.D., director of the West Virginia Center for End-of-Life Care, which oversees the Physician Orders for Scope of Treatment (POLST) program, a program comparable to Oregon’s POLST program, and the WV e-Directive Registry. “The Oregon POLST registry is the final step in completing the system and makes those orders available to treating health care providers in an emergency.”
One of the important aspects of the POLST program is its ability to launch important discussions among patients, their loved ones and health care professionals. When these discussions occur in the early stages of advanced illness for frailty, patients can share their wishes in case they are unable to communicate in a time of crisis. In addition, the program offers families some peace of mind because when a patient fills out a POLST form, the burden of family members who previously could only speculate on their loved one’s wishes, need not do so anymore.
“One of my colleagues, a rural doctor, taught me not to start my conversations about goals of care with code status,” explained study author Erik Fromme M.D., a palliative care specialist at OHSU. “Instead, he said, it should be the last question you talk about. Too often in health care the conversation begins and ends with resuscitation, when it would be much more helpful to know what kind of care a patient wants before they arrest. Our data, and programs like Oregon’s support the wisdom of this approach.”
READ – Study: Oregonians Who Have Registered Their Wishes Don’t Want Resuscitation, OPB.org
READ – An Oregon study points to better end-of-life care planning, Oregonian.com
Acomplishments of 2011 – a report to our supporters
Dear Friend of Compassion & Choices of Oregon,
We are pleased to tell you 2011 brought exciting growth and change to Compassion & Choices of Oregon – almost too many accomplishments to list.
As a dear friend, you already know our work is based on three key pillars: Support, Educate and Advocate. So I’ll share some of the more important highlights each of those areas.
Support for our clients seeking relief through the Oregon Death with Dignity Act was delivered with compassion, sensitivity, expertise and professionalism.
• More than 40 dedicated Client Support Team volunteers responded to 286 people who inquired about the Act, helped more than 85 persons receive a legal prescription, and supported 51 to use the medication. Aid in dying in Oregon remains safe, rare and protected.
• Those volunteers enlarged our client service across the state. Our largest number of clients (57 percent) come from the Portland metro and North Coast area. Other clients can be found in Eugene and Central Coast (21 percent), Southern Oregon and South Coast (11 percent), and Central and Eastern Oregon (11 percent).
• A team of medical directors began to provide peer-to-peer information for prospective prescribing doctors January. By anticipating doctor concerns, Compassion & Choices of Oregon helps avoid patient problems and assures patient access to the law.
• Our new client database collects, collates and reports relevant information about our services. These measurements enable accurate reporting and quick retrieval of data and benchmarks for management decisions.
• We recruited and trained new volunteers in Portland and Eugene and launched a new Client Support Team in Southern Oregon. Today, more than 70 volunteers from every corner of the state help assure choice is protected for all Oregonians.
• Compassion’s clients are well-served by Oregon’s great hospices – more than 85% are with hospice at time of death. Education about aid in dying remains our everyday work, and the word continues to spread across Oregon and the country.
• We launched this newly designed and rebuilt website in January; it provides doctors, pharmacists, hospices, patients, loved ones and others with easy access to vital information.
• We launched a Facebook page in March, and as of this writing, 430 people have ‘friended’ us. How about you?
• Millions watched the award-winning documentary ‘How to Die in Oregon,’ when it premiered on HBO in June. The film takes viewers inside the lives of patients, doctors, family members, Compassion & Choices volunteers and others as they confront the law and experience its impact on their individual stories. Advocates were rallied in March to stop a dangerous legislative assault in the Oregon House.
• Opponents put forward Oregon House Bill 2016 last March, which took the pejorative (and insulting) position that dying patients interested in accessing the Oregon law are mentally incapable and in need of counseling. The measure would have created unconscionable hurdles to citizen access to the law. A statewide communication effort stopped it in its tracks. Citizens from across the state signed petitions, wrote letters, made phone calls and sent emails to let lawmakers know that our rights to Death with Dignity are not to be tampered with or abridged.
Several leading Oregon foundations came forward with financial support for our work, including the Kinsman Foundation, Spirit Mountain Community Fund, PacificSource Charitable Foundation and Holzman Family Fund.
A joint operating agreement with the national office of Compassion & Choices makes our work in Oregon more efficient and your gifts more effective. We now share office space, information technology and back-office functions, significantly decreasing our overhead. This single, combined annual report exemplifies that partnership. Our cost to honor your gifts in this report was significantly less than previous years.
Liberty is on the march in Oregon. Our mission to be a comprehensive resource for Oregonians at the end of life is more secure than ever before, largely because you gave freely of your personal resources. We hope you will continue to support us in the future.
Gratefully,
Jason Renaud
Executive Director
Come watch ‘How to Die in Oregon’ at the NW Film Center
Please join Compassion & Choices of Oregon and its Board for a special screening of the Sundance Grand Jury Prize winning documentary ‘How To Die in Oregon‘ at the Northwest Film Center.
We hope to see you there to celebrate and learn about the great work done by the volunteers of Compassion & Choices of Oregon.
When: Monday November 14th 8:30 PM
Where: Northwest Film Center – 1219 SW Park Avenue in Portland.
How: tickets are $9 and can be purchased now ONLINE .
FYI: There will be some tickets at the door – but every screening of this film in Oregon SOLD OUT.
Annual Lunch a Success!
CCO’s Annual Luncheon on October 25th was our biggest annual event to date, with over 320 attendees! The preliminary fundraising report is that the event brought in over $54,000 at the lunch and another $10,000 in pledges, significantly more than last year.
CCO honored Volunteer of the Year Esther Bell with a standing ovation. Esther has been a Client Support volunteer with CCO since 2004 and has helped over 100 clients in that time. Look for some words from her in our printed newsletter this November!
Compassion Volunteer of the Year Esther Bell
Lynn Frank spoke eloquently about his mother’s experience using the Death with Dignity Law as a client of Compassion & Choices of Oregon. His story mixed humor and emotion as our client’s stories often do, and highlighted how important CCO’s work can be in supporting people to make their own choices at the end of life.
State Attorney General John Kroger spoke about the law on both a personal and professional level. He shared stories of how his grandmother’s death in a hospital didn’t reflect her vibrant life. He said, “We need to give people the opportunity to end their lives with spirit and control and dignity, my grandmother didn’t have the opportunity to make that choice,” and stated his confidence that the Attorney General’s office will continue to support the law that makes that choices possible. You can read more of John Kroger’s speech at the Lund Report.
Thank you to everyone who attended–it was wonderful to see so many of our long-time supporters there! And an extra big thank you to our Table Captains, who went above and beyond to bring new faces.
