Authors Propose Evolving POLST into MOELI as Optimal Way to Document, Communicate Patient Wishes, Preferences
Ensuring that patients’ wishes about their care are respected has long been a priority for post-acute and long-term care (PA/LTC) practitioners. “Standardizing Protection of Patients' Rights From POLST to MOELI (Medical Orders for End-of-Life Intervention),” an editorial in the September issue of JAMDA, discusses the evolution of platforms, tools, and forms designed to give patients opportunities to express and document their wishes and preferences. It also discusses the development of “Medical Orders for End-of-Life Intervention,” or MOELI, as an efficient and effective way to document and communication patient wishes.
The Patient Self-Determination Act of 1990 gave patients the right to decide what they wished to have done to their bodies by creating an advance directive (AD) and having these decisions recorded in their medical records. Then in the early 1990s, Oregon developed the first Physician Orders for Life-Sustaining Treatment (POLST) Paradigm to document and communicate patients’ wishes about medical treatment by creating portable medical orders.
The POLST has evolved over the years. For example, because many states allow advanced practice nurses and qualified physician assistants to sign and enter the form in patients’ medical records, several states replaced “Physician” with “Medical” or “Provider.” At the same time, “Life-Sustaining Treatment” suggests that the form is intended to guide only treatments designed to prolong life without addressing goals of patients who might not want this outcome. To address both of these issues, the authors proposed changing the name to the more inclusive and accurate “Medical Orders for End-of-Life Intervention” (MOELI).
The authors state that the MOELI is an upgrade to the POLST Paradigm. They suggest that it “fills some gaps in the original” and increases the range of patients who can use it by expanding its use beyond those individuals with a life expectancy of 12 months or less due to illness or frailty. They say, “We hope that this stimulates discussions that will motivate various POLST organizations to collaborate in creating a standardized national form. Its adoption would have to be followed by the creation of multiple cultural adaptations that go beyond mere translation.” They also recommend development of a national evaluative database, creation of institutional policies and resources that support the paradigm’s use, and increased efforts to educate health care professionals and the general public about MOELI.