MOLST form awareness needed

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As important as Medical Orders for Life-Sustaining Treatment are for many people to have, there is a large gap between those that could benefit from a MOLST form and those that actually have one, a gap which sources say requires more education and action to help close.

New York’s Medical Orders for Life-Sustaining Treatment, better known as the MOLST form, is a bright pink medical order that tells others the patient’s medical orders for life-sustaining treatment. Though no adult is restricted from filling out a MOLST form, it is designed to improve the quality of care for seriously ill people at the end of life, according to molst.org.

Rodney Maine, aging services specialist at Tompkins County Office for the Aging, put is more simply.

“It’s really a form that speaks for someone when they’re not able to speak for themselves due to a medical emergency,” Maine said.

Suzanne Anderson, medical director at Hospicare in Ithaca, has helped many patients complete and understand MOLST forms. She said the medical orders, which have been around for over a decade, are essential in a day and age of advanced medical capabilities.

“Over the last several decades, we’ve gotten to a point where we can really keep a body technically alive for long periods of time but often with no quality of life and with no hope of recovery,” she said. “The MOLST form is actually meant to protect you against excessive intervention by the medical care system.”

Once the form is filled out, Anderson said it is best to send a copy to a person’s primary care physician, their local hospital and their local hospice center if they are a patient there. The original form is best placed on the fridge in the person’s home, as that is there EMTs are trained to look for instructions before immediately trying to resuscitate someone.

Anderson said that the default in the medical care system is to do everything possible to keep somebody alive, but that is not always what a person wants, which is why MOLST forms are so important.

“Many people don’t want to have efforts – what we call heroic efforts – made to keep their body alive if they have a terminal illness,” Anderson said. “And yet, with the way that the law works, a patient who shows up without any advanced directives … will have everything done when they show up.”

The MOLST form is broken into two basic sections: resuscitation instructions and orders for other life-sustaining treatment and future hospitalization. The form covers areas like consent for CPR, do not resuscitate (DNR) instructions, palliative care protocols, intubation, antibiotics and IV fluids.

The form must be signed by a physician or nurse practitioner and two witnesses, with either the patient’s signature, their verbal consent or their health care proxy’s signature to verify all the specifications in the form are correct. Every six months, the form should be looked through and possibly changed or completely voided without a new version, depending on the desires of the person who’s filling it out.

MOLST forms are physician’s orders, unlike documents like a living will, which provide very specific instructions for care. This specificity can be a great learning experience for the patient, the physician and the family members involved, said Deb Traunstein, a social worker at Cayuga Medical Center’s Advanced Illness Management program.

“I really think of it as a gift that a person can give to their family and other loved ones because it allows a person while they’re still capable, mentally and physically, of making decisions for their care, they can do it ahead of time so that, during a medical crisis … other people don’t have to be making these tough decisions,” Traunstein said.

Nurse practitioner Jane Schantz agreed, saying that filling out a MOLST form can introduce the health care planning conversation when it is not a life-or-death situation.

“It can help guide patients to what kinds of things they should be thinking about ahead of time,” Schantz said. “Talking about these things before a crisis is important because at least you become familiar with what these choices are.”

Traunstein said that, when she goes through the form with patients, it involves a lot of education because many people have misconceptions on what medical procedures look like for those who are close to dying.

For example, CPR is often depicted in film and television shows as being a life-saving procedure that allows a person to return to their previous quality of life immediately after receiving it, Anderson said, but that is not the case for someone with a more fragile physical state.

“This is not just like waving a wand and then their heart will start again,” she said. “It’s actually a very traumatic event.”

It is important for physicians to take on an educational role regarding MOLST forms, Anderson said. Recent legal measures allow Medicare reimbursements for physicians’ conversations with their patients about end of life and advanced services, but Anderson said this still is not enough.

“So many primary care physicians really just don’t have the time to go over all of this stuff with their patients, and they just don’t think about it,” Anderson said. “I would love to have it be something that every doctor does with their patient with a serious illness.”

Another issue, Anderson said, is when those that have MOLST forms do not review them every six months, as is recommended. Desires for end-of-life treatment change, Anderson said, which means the forms may require revision that many people are not taking advantage of.

Schantz said many gaps in the MOLST system can be explained by society’s aversion to death and conversations relating to dying, which makes it difficult to close the coverage gap.

“[Promoting] advanced health care planning as a general concept and making conversations about death and dying less taboo and much more norm are some of the best things that we can do,” Schantz said.

The best way to combat that fear, Traunstein said, is frequent education and early conversations.

Those looking for more information regarding MOLST forms are encouraged to visit compassionandsupport.org or health.ny.gov, great resources for learning all there is to know about MOLST.

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