Improve Communication Between
the Family, Nurse, and Patient
Traditionally, a patient’s preferences regarding EOL
have been communicated via advanced directives (e.g.,
living wills, DNR orders). However, advanced directives
have not always been effectively communicated
to the healthcare team, particularly in cases where the
patient has been transferred among facilities.
To address that problem, physician orders for lifesustaining
treatment (POLST) (also known in some
states as medical orders for life-sustaining treatment)
have been developed (Mitchell, 2011). POLST seek to
clarify and solidify wishes already expressed in a living
will or advanced directive. The goal is to transfer
a patient’s wishes into medical orders via a brightly
colored form that addresses artificial nutrition, pain
management, antibiotics, comfort measures, and other
medical interventions.
POLST programs are meant to complement, not
replace, advanced directives, and are based on EOL
conversations with a healthcare provider. Because
oncology nurses in this study identified several areas
where communication between patients, families, and
caregivers was less than optimal, the use of POLST or
a similar tool is highly recommended.