Podcasts about physician orders

This episode is part of a special series that focuses on organizations that received grant funding from the COPIC Medical Foundation for initiatives that address the issue of reducing fragmentation across care settings. Dr. Zacharias welcomes Dr. Matthew Gonzales and Dr. Deborah Unger who are affiliated with a grant provided to the Providence Portland Medical Foundation. Grant funding supported Providence and the Oregon Physician Orders for Life Sustaining Treatment (POLST) Registry for a partnership to build a bi-directional interface which integrates Providence's Epic electronic health record with the Registry. Dr. Gonzales and Dr. Unger discuss about how POLST is designed to respect people's wishes around care/treatment inside and outside of health care settings. They also talk about how POLST is utilizing digital technology to inform others across different systems, the challenge of state-by-state legislation, and the insight gained through the project so far. Feedback or episode ideas email the show at wnlpodcast@copic.com Disclaimer: Information provided in this podcast should not be relied upon for personal, medical, legal, or financial decisions and you should consult an appropriate professional for specific advice that pertains to your situation. Health care providers should exercise their professional judgment in connection with the provision of healthcare services. The information contained in this podcast is not intended to be, nor is it, a substitute for medical diagnosis, treatment, advice, or judgment relative to a patient's specific condition.

A complex landscape of state laws overlays the direct access testing model, ranging from physician order requirements, such as telemedicine standards and the corporate practice of medicine doctrine, to specimen collection considerations, including how the varying options for collection could impact a model. How do these factors combine to create a roadmap for companies navigating the direct access testing industry? On the third episode of our four-part series on direct access laboratory testing, Epstein Becker Green attorneys Bob Hearn, Amy Lerman, and Megan Robertson discuss physician ordering and specimen collection considerations for direct access laboratory testing stakeholders.   Stay tuned for the final episode of our special series on direct access laboratory testing.   Visit our site for related resources and email contact information: https://www.ebglaw.com/dhc63.   Subscribe for email notifications: https://www.ebglaw.com/subscribe.   Visit: http://diagnosinghealthcare.com.   The EMPLOYMENT LAW THIS WEEK® and DIAGNOSING HEALTH CARE podcasts are presented by Epstein Becker & Green, P.C. All rights are reserved. This audio recording includes information about legal issues and legal developments. Such materials are for informational purposes only and may not reflect the most current legal developments. These informational materials are not intended, and should not be taken, as legal advice on any particular set of facts or circumstances, and these materials are not a substitute for the advice of competent counsel. The content reflects the personal views and opinions of the participants. No attorney-client relationship has been created by this audio recording. This audio recording may be considered attorney advertising in some jurisdictions under the applicable law and ethical rules. The determination of the need for legal services and the choice of a lawyer are extremely important decisions and should not be based solely upon advertisements or self-proclaimed expertise. No representation is made that the quality of the legal services to be performed is greater than the quality of legal services performed by other lawyers.

Objectives: • Examine what is POLST and its use in Northeast Georgia Health System. • Review patient criteria for POLST qualification. • Understand POLST's role in assisting patients with expressing their medical wishes. • Recognize when POLST is appropriate for patient completion.

Join special guest, Leonard R. Hock Jr., DO, MACOI, CMD, and our host, Diane Sanders-Cepeda, DO, CMD, for this episode of FMDA's Journal Club, Resident Wishes: DNR, POLST, Advanced Care Planning, and More. Our learning objectives for this session were: Discuss current approaches to advance care planning. Revisit the value and limitations of do-not-resituate (DNR) orders. Describe the opportunities and challenges for Physician Orders for Life-Sustaining Treatment (POLST) in Florida. Discuss the future state of advance care planning, palliative, and hospice care delivery. Recorded: August 31, 2022 Special Guest: Leonard R. Hock Jr., DO, MACOI, CMD Hosted by: Diane Sanders-Cepeda, DO, CMD Available Credit: The American Board of Post-Acute and Long-Term Care Medicine (ABPLM) issues CMD credits for AMDA On-The-Go and affiliate podcast episodes as follows: Claim CMD Credit

Living Will. DNR. Advance Directive. POLST.  You know these forms are important. But are they the same? Do you need all of them? What are they for? And when would you need them?   Forms are location specific. Do an online search for "[where you live] and [name of form]" or ask your lawyer to get the right version for you.   Recap of summary:  Everyone over the age of 18 should specify their wishes and designate a health care proxy, ideally with an Advance Directive or Living Will and Medical Power of Attorney If you're close to the end of life or frail and the risk of complications from resuscitation would not be worth it, that's when you want a Do Not Resuscitate (DNR) order If you're close to the end of life and don't want to artificially extend your life and you want to be sure that your wishes are honored (and it's available in your area), get a Physician Orders for Life Sustaining Treatment (POLST)

Maureen Kures, RN is the CEO of www.RadiantMourning.com. She is on a mission to guide families to decide, document, and discuss their final chapter plans to bring peace for those who live on. Now she facilitates family conversations and leads virtual group workshops to replace drama, trauma, and chaos with calm, ease, and peace. A few highlights from the show: 1. Physician Orders for Life-Sustaining Treatment (POLST) is a form for people with life-limiting illnesses who frequently require emergency medical care. https://polst.org/ 2. DNR or do not resuscitate is an important part of the form. It is only valid in a hospital setting. If you are having surgery, ask your surgeon if a DNR will be reinforced during surgery. 3. Full estate planning is important even if you believe that you don't have much to leave behind. 4. Anyone can get Advance Directive forms off the internet for free and they can be changed at any time. Typically two witnesses or notary public are required in order for it to be valid. 5. Regret is a wasted emotion. Learn from what has happened and grow. Follow and learn more about Maureen at: https://www.facebook.com/radiantmourning https://www.linkedin.com/in/maureen-kures-48377126/ https://www.youtube.com/channel/UCz9b2fdIAVwk_AfveOV2khQ Free Guide: http://startthetalknow.com/ About Me: In 2011, I was diagnosed with Hodgkin's Lymphoma, out of the blue. I did not have any prior health concerns or issues. Fast forward, the dreaded cancer diagnosis opened my eyes, introduced me to my purpose, and lead me to where I am today. As a Cancer Doula, I use my 10-years of experience with cancer to support and guide others diagnosed with cancer. Many people are not familiar with what a cancer doula is. Think of me as a personal health care advocate. Schedule a free 30-minute meet and greet call to learn more. https://bit.ly/OTOSDiscovery Looking for a gift for yourself, a friend, or a loved one who has been diagnosed with cancer or they are a caregiver? Visit my shop. Thanks for joining us on today's episode of the Navigating Cancer TOGETHER podcast! If you enjoyed today's episode, please head over to Apple Podcasts and leave a rate and review to help me reach even more people that are facing cancer. Make sure you visit On the Other Side, follow me on Instagram, or sign up for my bi-weekly newsletter to get information and resources related to cancer. https://www.ontheotherside.life/ --- Send in a voice message: https://anchor.fm/navigatingcancertogether/message Support this podcast: https://anchor.fm/navigatingcancertogether/support

Drs. Molly Sinert and Jon Furuno join Dr. David Ha (@DHpharmd) to discuss the prevalence of antibiotic use and its harms and benefits in reducing suffering and providing comfort during end-of-life care. Learn more about the Society of Infectious Diseases Pharmacists: https://sidp.org/About Twitter: @SIDPharm (https://twitter.com/SIDPharm) Instagram: @SIDPharm (https://www.instagram.com/sidpharm/) Facebook: https://www.facebook.com/sidprx LinkedIn: https://www.linkedin.com/company/sidp/ References: Sinert et al. Guidance for Safe and Appropriate Use of Antibiotics in Hospice Using a Collaborative Decision Support Tool. Accessed October 6, 2021. https://oce-ovid-com.laneproxy.stanford.edu/article/00129191-202008000-00005/HTMLA Albrecht JS, McGregor JC, Fromme EK, Bearden DT, Furuno JP. A Nationwide Analysis of Antibiotic Use in Hospice Care in the Final Week of Life. Journal of Pain and Symptom Management. 2013;46(4):483-490. doi:10.1016/j.jpainsymman.2012.09.010 Furuno JP, Noble BN, Fromme EK. Should we refrain from antibiotic use in hospice patients? Expert Review of Anti-infective Therapy. 2016;14(3):277-280. doi:10.1586/14787210.2016.1128823 Servid SA, Noble BN, Fromme EK, Furuno JP. Clinical Intentions of Antibiotics Prescribed Upon Discharge to Hospice Care. Journal of the American Geriatrics Society. 2018;66(3):565-569. doi:10.1111/jgs.15246 Gaw CE, Hamilton KW, Gerber JS, Szymczak JE. Physician Perceptions Regarding Antimicrobial Use in End-of-Life Care. Infection Control & Hospital Epidemiology. 2018;39(4):383-390. doi:10.1017/ice.2018.6 Broom J, Broom A, Good P, Lwin Z. Why is optimisation of antimicrobial use difficult at the end of life? Internal Medicine Journal. 2019;49(2):269-271. doi:10.1111/imj.14200 Kwon KT. Implementation of Antimicrobial Stewardship Programs in End-of-Life Care. Infect Chemother. 2019;51(2):89-97. doi:10.3947/ic.2019.51.2.89 Datta R, Topal J, McManus D, et al. Perspectives on antimicrobial use at the end of life among antibiotic stewardship programs: A survey of the Society for Healthcare Epidemiology of America Research Network. Infection Control & Hospital Epidemiology. 2019;40(9):1074-1076. doi:10.1017/ice.2019.194 Lopez S, Vyas P, Malhotra P, et al. A Retrospective Study Analyzing the Lack of Symptom Benefit With Antimicrobials at the End of Life. Am J Hosp Palliat Care. 2021;38(4):391-395. doi:10.1177/1049909120951748 Ito H. Antibiotics in end-of-life care: What is the driving factor? Infectious Diseases Now. Published online July 7, 2021. doi:10.1016/j.idnow.2021.07.003 Kates OS, Krantz EM, Lee J, et al. Association of Physician Orders for Life-Sustaining Treatment With Inpatient Antimicrobial Use at End of Life in Patients With Cancer. Open Forum Infectious Diseases. 2021;8(8). doi:10.1093/ofid/ofab361 Hickman SE, Nelson CA, Moss AH, Tolle SW, Perrin NA, Hammes BJ. The consistency between treatments provided to nursing facility residents and orders on the physician orders for life-sustaining treatment form. J Am Geriatr Soc. 2011; 59(11): 2091–2099. doi:10.1111/j.1532-5415.2011.03656.x. Implementing an Antibiotic Stewardship Program: Guidelines by the Infectious Diseases Society of America and the Society for Healthcare Epidemiology of America. Clinical Infectious Diseases, Volume 62, Issue 10, 15 May 2016, Pages e51–e77, https://doi.org/10.1093/cid/ciw118

Dr. Steven Baumrucker and Amy Vandenbrouke, JD, Director of National POLST, discuss Physician Orders for Life Sustaining Treatment (POLST) and the push for a national standard.

Amy Vandenbroucke, JD Executive Dir., National POLST Karl Steinberg, MD, HMDC, CMD,  President-Elect, AMDA   References: Marshall B. Kapp, MPH, JD, "Overcoming Legal Impediments to Physician Orders for Life-Sustaining Treatment", AMA Journal of Ethics, 2015. National POLST Recording Date:  5/5/2020 Available Credit: 0.25 CMD-Clinical    

Are you trying to keep up with the general medicine literature but you are saturated with Covid Coughs, Swabs, Oxygenation, Isolation, Ventilation, and the Mortality of the Nation? Your ears are in the right place as we bring you last months most relevant (and sometimes less relevant) general medicine articles.---------------------------------------------------------- In this month's episode......why we shouldn't leave all the cycling to work to the anaesthetists...Association of injury-related hospital admissions with commuting by bicycle in the UK: a prospective population-based study. BMJ.https://doi.org/10.1136/bmj.m336...ACEI/ARBs shine through some difficult COVID related PR...Qiao, Yao et al. “Association Between Renin-Angiotensin System Blockade Discontinuation and All-Cause Mortality Among Persons With Low Estimated Glomerular Filtration Rate.” JAMA internal medicine, e200193. 9 Mar. 2020, doi:10.1001/jamainternmed.2020.0193...a new treatment regimen injects some life into HIV care...Orkin, Chloe et al. “Long-Acting Cabotegravir and Rilpivirine after Oral Induction for HIV-1 Infection.” The New England journal of medicine vol. 382,12 (2020): 1124-1135. doi:10.1056/NEJMoa1909512....the ISCHAEMIA trial, morbidly expensive but no extra mortality...Maron, David J et al. “Initial Invasive or Conservative Strategy for Stable Coronary Disease.” The New England journal of medicine vol. 382,15 (2020): 1395-1407. doi:10.1056/NEJMoa1915922...brush up on treatment options for CFS/ME...Kim, Do-Young et al. “Systematic review of randomized controlled trials for chronic fatigue syndrome/myalgic encephalomyelitis (CFS/ME).” Journal of translational medicine vol. 18,1 7. 6 Jan. 2020, doi:10.1186/s12967-019-02196-9...a few pearls to help with your ICU redeployment...Lee, Robert Y et al. “Association of Physician Orders for Life-Sustaining Treatment With ICU Admission Among Patients Hospitalized Near the End of Life.” JAMA, vol. 323,10 950–960. 16 Feb. 2020, doi:10.1001/jama.2019.22523Lamontagne, François et al. “Effect of Reduced Exposure to Vasopressors on 90-Day Mortality in Older Critically Ill Patients With Vasodilatory Hypotension: A Randomized Clinical Trial.” JAMA, vol. 323,10 938–949. 12 Feb. 2020, doi:10.1001/jama.2020.0930...and finally, the great medical conundrum of our time...Ukai, Tomohiko et al. “Habitual tub bathing and risks of incident coronary heart disease and stroke.” Heart (British Cardiac Society), heartjnl-2019-315752. 24 Mar. 2020, doi:10.1136/heartjnl-2019-315752---------------------------------------------------------- Get in touch! @JournalSpotting or journalspotting@gmail.comWe'd love to hear from you: what you thought of the show, what you would like to hear, and if you have any articles that you would like us to share with the general medicine world! A wise man at your ARCP once said: "It didn't happen unless you've filled in a feedback form". (But seriously, we'd love to hear what you think!)

  If you are stuck at home and without basic legal documents, listen up. In the spirit of offering what I can to help people gain some piece of mind amidst the panic and uncertainty of the pandemic, here are some resources that you can use to get the basics in order, for now. Although none of the documents I’m discussing take the place of a comprehensive estate plan, they are all good things to have. And most of them are documents that you can put in place with minimal or no expense as long as you have access to the internet, a printer, and some cooperative neighbors willing to stay six feet away while you sign them. Once you do sign them, place them in a safe place, let your loved ones know where to find them in case you do get sick, and then, please, go out and take a walk. Advance Health Care Directives An Advance Health Care Directive, also known as a Health Care Proxy or Durable Power of Attorney for Health Care  and Living Will in some states, appoints people to act as your Agents to make medical decisions for you if you are unable to make them for yourself.   Here is a downloadable Advance Health Care Directive form for California that follows the California Probate Code’s statutory form. The AARP offers free, downloadable Advance Directives for all fifty states here: The California Hospital Association offers a free downloadable form for California here. If you are a Kaiser member, Kaiser Permanente offers a downloadable form here. If you would like to learn more about end of life planning and palliative care, please listen to Dr. Jessica Zitter’s interview on my podcast, Life Death Law. She has so much to say about how to be prepared, who to choose as your Agent, and how to negotiate a vist to the ICU. DNR and POLST forms A DNR Order tells emergency medical personnel that you don’t want CPR or other measures, such as intubation, if your heart stops beating. This form, however, needs to be signed by a doctor to be valid, so it’s not exactly a DIY resource. Still, if you are concerned, please do contact your doctor or local Health Department to find out how to get this in place. A POLST form, which is often printed on bright pink paper, is another medical order that is similar to, but broader than, a DNR Order. The name stands for Physician Orders for Life-Sustaining Treatment and it is exactly that — a medically binding order that states what you do, and don’t, want at end of life.  For more information about POLST forms, you can go here. Durable Power of Attorney A Durable Power of Attorney is a legal document that names Agents who can act for you financially, doing things such as writing checks on your behalf, paying your bills, managing your investments, withdrawing assets from your retirement accounts, and paying your taxes.  California offers a simple Durable Power of Attorney as part of its Probate Code.  You can find this many places, but here’s one link. Wills A Will is the last on my list of basic estate documents that everyone should have. If you don’t write one, each state has a set of rules that will determine who will get your property at death (called the laws of intestate succession)  and a judge will have to appoint guardians for your minor children without any input from you.  So, how can you make a Will right now, if you can’t leave the house? I have three suggestions: If you live in California, you can download a simple fill-in-the-blank form offered for free by the State Bar Association here. If you want to do a more customized Will, and you can afford to pay 89.99, you can use WillMaker, software that uses a question and answer format to produce Wills, Durable Powers of Attorney and Health Care Directives for all states, except Louisiana. You can download Quicken WillMaker and Trust 2020. You can create an Online Will for $59.99 at Nolo.com for all states except Louisana.

  If you are stuck at home and without basic legal documents, listen up. In the spirit of offering what I can to help people gain some piece of mind amidst the panic and uncertainty of the pandemic, here are some resources that you can use to get the basics in order, for now. Although none of the documents I’m discussing take the place of a comprehensive estate plan, they are all good things to have. And most of them are documents that you can put in place with minimal or no expense as long as you have access to the internet, a printer, and some cooperative neighbors willing to stay six feet away while you sign them. Once you do sign them, place them in a safe place, let your loved ones know where to find them in case you do get sick, and then, please, go out and take a walk. Advance Health Care Directives An Advance Health Care Directive, also known as a Health Care Proxy or Durable Power of Attorney for Health Care  and Living Will in some states, appoints people to act as your Agents to make medical decisions for you if you are unable to make them for yourself.   Here is a downloadable Advance Health Care Directive form for California that follows the California Probate Code’s statutory form. The AARP offers free, downloadable Advance Directives for all fifty states here: The California Hospital Association offers a free downloadable form for California here. If you are a Kaiser member, Kaiser Permanente offers a downloadable form here. If you would like to learn more about end of life planning and palliative care, please listen to Dr. Jessica Zitter’s interview on my podcast, Life Death Law. She has so much to say about how to be prepared, who to choose as your Agent, and how to negotiate a vist to the ICU. DNR and POLST forms A DNR Order tells emergency medical personnel that you don’t want CPR or other measures, such as intubation, if your heart stops beating. This form, however, needs to be signed by a doctor to be valid, so it’s not exactly a DIY resource. Still, if you are concerned, please do contact your doctor or local Health Department to find out how to get this in place. A POLST form, which is often printed on bright pink paper, is another medical order that is similar to, but broader than, a DNR Order. The name stands for Physician Orders for Life-Sustaining Treatment and it is exactly that — a medically binding order that states what you do, and don’t, want at end of life.  For more information about POLST forms, you can go here. Durable Power of Attorney A Durable Power of Attorney is a legal document that names Agents who can act for you financially, doing things such as writing checks on your behalf, paying your bills, managing your investments, withdrawing assets from your retirement accounts, and paying your taxes.  California offers a simple Durable Power of Attorney as part of its Probate Code.  You can find this many places, but here’s one link. Wills A Will is the last on my list of basic estate documents that everyone should have. If you don’t write one, each state has a set of rules that will determine who will get your property at death (called the laws of intestate succession)  and a judge will have to appoint guardians for your minor children without any input from you.  So, how can you make a Will right now, if you can’t leave the house? I have three suggestions: If you live in California, you can download a simple fill-in-the-blank form offered for free by the State Bar Association here. If you want to do a more customized Will, and you can afford to pay 89.99, you can use WillMaker, software that uses a question and answer format to produce Wills, Durable Powers of Attorney and Health Care Directives for all states, except Louisiana. You can download Quicken WillMaker and Trust 2020. You can create an Online Will for $59.99 at Nolo.com for all states except Louisana.

A Physician Orders for Life-Sustaining Treatment, or “POLST” makes sure that decisions about care at the end of life are written as medical orders that health care providers must follow. The POLST should list the medical care people do or do not want, given their current health condition. Without a POLST, emergency care providers generally must provide such medical treatment to keep people alive. Learn why this is so important to you on this episode of the Bottled Business Sense Show. View show at: http://wfblegalconsulting.com/bbss/ WFB Legal Consulting--LAWYER FOR BUSINESS--A BEST ASSET PROTECTION Services Group

Thousands upon thousands of pro-lifers are preparing for the March for Life 2020 to make their presence known and voices heard in defense of the unborn and their mothers. The 47th annual March for Life in Washington, DC takes place on January 24th. This year’s theme, “Life Empowers: Pro-Life is Pro-Woman” carries a special historic moment with it. 2020 marks the 100th anniversary of the 19th Amendment of the Constitution which guarantees women the right to vote. The movement to pass the 19th Amendment was led by women suffragists, considered the early pioneers of the feminist movement, who understood that abortion ends a life and harms women. To delve into the details of this year’s March and today’s pro-life movement we speak with Jeanne Mancini, President of the March for Life. Then in our mailbag segment, we answer questions regarding end-of-life care decisions and POLST forms that many doctors ask patients to fill out. We wrap up the show with our bricklayer segment, giving you practical tips on how to begin building bridges between faith and politics one brick at a time. This week we discuss how to get involved with a local March for Life. Useful Links: Minnesota's March for Life: https://www.mccl.org/march Archdiocese of St. Paul & Minneapolis March for Life registration: https://www.archspm.org/marchforlife/ Catholic Healthcare Directives & End-of-Life Care Decisions Guide: www.MNCatholic.org/healthcaredirective Response to MMA revisions of the Provider Orders for Life-Sustaining Treatment (POLST) form: https://www.mncatholic.org/response-mma-revisions-provider-orders-life-sustaining-treatment-polst-form/ A Pastoral Statement on Physician Orders for Life-Sustaining Treatment (POLST): https://www.mncatholic.org/stewards-of-the-gift-of-life/ Guidance for completing the POLST form: https://www.mncatholic.org/guidance-completing-polst-form/

POLST: Physician Orders for Life-Sustaining Treatment. Why and when should you complete this form? Dr. Susan Tolle answers these important questions. She founded and has directed the Oregon Health & Science University Center for Ethics in Health Care since 1989. She has shepherded its growth into an internationally recognized ethics center with programs such as the Physician Orders for Life-Sustaining Treatment (POLST) program and the Oregon POLST registry. She is a practicing internist of general medicine and geriatrics at OHSU. #Portland

POLST: Physician Orders for Life-Sustaining Treatment. Why and when should you complete this form? Dr. Susan Tolle answers these important questions. She founded and has directed the Oregon Health & Science University Center for Ethics in Health Care since 1989. She has shepherded its growth into an internationally recognized ethics center with programs such as the Physician Orders for Life-Sustaining Treatment (POLST) program and the Oregon POLST registry. She is a practicing internist of general medicine and geriatrics at OHSU. #Portland

Join Dr. Lael Duncan and TNS host Steve Heilig for a wide-ranging discussion of innovations and controversies in end-of-life care. Lael is the medical director of consulting services for the Coalition for Compassionate Care of California, a Sacramento-based non-profit organization and interdisciplinary partnership of thought-leaders dedicated to promoting high-quality, compassionate care for everyone who is seriously ill or nearing the end of life. She is an expert educator on Physician Orders for Life-Sustaining Treatment (POLST), end-of-life communication between patients and providers, advance care planning, and legislation that impacts end-of-life care in California. Dr. Duncan consults with health care organizations, medical providers, and communities to improve access to care that honors patient values.

Randi Belisomo, DBe, is the President and Co-Founder of Life Matters Media. She serves as a reporter at WGN-TV in Chicago and is a frequent contributor to Chicago Public Radio, Relevant Radio and WGN 720 AM. She writes about issues related to end of life healthcare and policy for Reuters Health.Belisomo holds a doctorate from Loyola University-Chicago in bioethics and health policy, as well as an M.S.J. from Northwestern University’s Medill School of Journalism. She is a Phi Beta Kappa graduate of the University of Notre Dame. She is a multiple Emmy Nominee and a Peter Lisagor Award winner for best in-depth series, best feature and best sports story.She currently serves on the boards of Living Water International and Mental Health America- Illinois. She is a chair person of the Carlos Hernandez Award in Meritorious Journalism at DePaul University and a member of the Illinois Task Force for the Physician Orders for Life Sustaining Treatment (POLST). She is a Respecting Choices certified advance care planning facilitator and instructor.Having served as a caregiver and widowed at a young age, Belisomo knows that end of life issues impact everyone at some point. She hopes that through the work of Life Matters Media, the inevitable challenges with which life presents and often surprises us will be made easier for the organization’s audiences. See acast.com/privacy for privacy and opt-out information.

Most states have passed legislation to honor a type of advanced directive, commonly known as a POLST, for Physician Orders for Life Sustaining Treatment. It is basically a more detailed and specific DNR (do not resuscitate). Patients consistently report preferences to die peacefully at home but all too often end up dying in hospitals, with advanced medical interventions and an uncomfortable end. Most clinicians are not adequately prepared to address this issue. End-oflife care is about listening to patients and their families and engaging them in honest dialogue about options and outcomes--easy to say, but excruciatingly hard to do. This presentation will explore the economic and societal issues of end-of-life care for an aging society and encourage the use of an enduring set of medical orders guided by clinicians but chosen by patients and their families. This session will discuss POLST and ongoing research in the state of Oregon, which has proven that the POLST program more accurately conveys end-of-life preferences that are more likely followed by medical professionals. The POLST program has been a key vehicle in Oregon's successful efforts to increase the effectiveness of advance care planning and decrease unwanted hospitalizations at the end-of-life.

The first report reviews medical statistics commonly used in "risk" shared by physicians when patients are making an informed decision. The second report reviews a new program (Physician Orders for Life-Sustaining Treatment or POLST) aimed at refining end of life decisions.

Guest: Karl Steinberg, MD, CMD Host: Eric Tangalos, MD "Advance directive" is an umbrella term that encompasses end-of-life documents, including a living will and durable power of attorney for healthcare. Such documents can be scary for many patients, and as such, advance directives are not very common among the general US population. Yet these documents can be powerful tools in ensuring patients receive the type of care they desire. What do physicians need to know about advance directives in caring for patients at the end of life? Dr. Karl Steinberg, associate medical director for skilled nursing care at Scripps Coastal Medical Center in Vista, California, discusses variations, misconceptions and confusion surrounding advance directives, and says there is room for improvement. Many states have enacted Physician Orders for Life Sustaining Treatment (POLST) programs to address end-of-life care issues. What do these programs involve, and how effective are such programs in alleviating confusion with end-of-life care? Dr. Eric Tangalos hosts.

Background: Advance Care Planning (ACP) is an emerging strategy to ensure that well-reflected, meaningful and clearly documented treatment preferences are available and respected when critical decisions about life-sustaining treatment need to be made for patients unable to consent. In Germany, recent legislation confirms that advance directives (AD) have to be followed if they apply to the medical situation, but implementation of ACP has not yet been described. Methods/Design: In a longitudinal controlled study, we compare 1 intervention region (4 nursing homes [n/hs], altogether 421 residents) with 2 control regions (10 n/hs, altogether 985 residents). Inclusion went from 01.02.09 to 30.06.09, observation lasted until 30.06.10. Primary endpoint is the prevalence of ADs at follow-up, 17 (12) months after the first (last) possible inclusion. Secondary endpoints compare relevance and validity of ADs, process quality, the rate of life-sustaining interventions and, in deceased residents, location of death and intensity of treatment before death. The regional multifaceted intervention on the basis of the US program Respecting Choices (R) comprises training of n/h staff as facilitators, training of General Practitioners, education of hospital and ambulance staff, and development of eligible tools, including Physician Orders for Life-Sustaining Treatment in case of Emergency (POLST-E). Participation data: Of 1406 residents reported to live in the 14 n/hs plus an estimated turnover of 176 residents until the last possible inclusion date, 645 (41%) were willing to participate. Response rates were 38% in the intervention region and 42% in the control region. Non-responder analysis shows an equal distribution of sex and age but a bias towards dependency on nursing care in the responder group. Outcome analysis of this study will become available in the course of 2011. Discussion: Implementing an ACP program for the n/hs and related health care providers of a region requires a complex community intervention with the effect of nothing less than a cultural shift in this health care sector. This study is to our knowledge the first to develop a strategy for regional implementation of ACP, and to evaluate its feasibility in a controlled design.