Pub. 3 2019 Issue 2

An AD allows the patient to put into writing their wishes about medical treatments for the end- of-life (EOL) care. It can be used as a guide for family members, loved ones, and medical providers to make decisions about treatments according to the patient’s wishes. The Utah AD is a legal document that is signed by the competent individual and a witness. It does not need to be notarized or signed by a lawyer but can only be completed by the patient when they have full capacity to make decisions. If they are unconscious and no one has been documented as the medical POA, then Utah law says the medical provider can talk to the spouse, adult children, a parent or grandparent. This document is not a medical order but a guide when the patient gets to the hospital. The patient may end up in the ICU on a ventilator, feeding tubes, and central lines with heroic efforts being made before the patient’s wishes are known. Medicare has included ACP in the Annual Wellness Visit (AWV). If physicians take the time during the AWV, they can bill for ACP (99497 for the first 16 to 30 minutes, at a cost of $85.93, and 99498 for each additional 30 minutes at a cost of $74.83). How Can We Improve our ACP in Utah? We need to make this conversation less about death and more about planning for an emergency. Utah excels in emergency preparedness when it comes to disaster preparedness. As family physicians, we need to help patients understand that this kind of emergency preparedness is just as important, if not more so. For links to the forms mentioned in this article and other useful websites to help you start talking with your patients about end-of-life options, visit utahafp.org/ACP for information. Differences Between POLST and Advance Directives CHARACTERISTICS POLST ADVANCE DIRECTIVES Population For the seriously ill All adults Time frame Current care Future care Who completes the form? Health care professionals Patients Resulting form Medical orders (POLST) Advance directive Health care agent or surrogate Can engage in discussion if a patient lacks the capacity Cannot complete Portability Provider responsibility Patient/family responsibility Periodic review Provider responsibility Patient/family responsibility Dr. Collett is the Chair of Utah POLST Registry, Utah Representative on National POLST, and needs more than an AD; you need to discuss the POLST form (Provider Order of Life-Sustaining Treatment). The POLST is very different from the advance directive, as it is a medical order that EMTs and paramedics can follow if the patient is found without a pulse and is not breathing. The Utah POLST Form is a one-page document with medical orders about CPR and feeding tubes and has to be signed by a licensed medical provider and the patient or the POA. The POLST form was developed to improve the quality of patient care by creating a system that identifies patients’ wishes about medical treatment. The discussion involves a conversation about their under- standing of their medical conditions and their goals of care in order to create a set of portable medical orders that reflect the patient’s desires. A key component of the POLST is a thoughtful, facilitated conversation about advance care planning between health care profession- als, the patient, and those close to them to determine what treatments th patient wants or does not want, based on their personal beliefs and their current state of health. In these conversations, patients are informed of their treatment options and, if they wish, their health care profession l completes a POLST form based on the patient’s expressed treatment preferences. POLST is not for everyone; only patients with serious illnesses or frailty sho l have a OLST Form. For thes patients, their cur- rent health status indicates the need for standing medical orders for emergent medical care. For healthy patients, an AD is an appropriate tool for m king future end-of-life care wishes known to loved ones and designating a du- rable health care POA. The POLST form can be filled out with the POA if the patient is unable to communicate their wishes. However, the AD can only be filled out by a patient who is competent to make their own decisions. The Utah Advance Directive is a four-page document with written instructions stating a patient’s preferences for medical care if they are un ble t make d cisions for themselves and who can speak for them. The first page of this form designates the durable medical power of at- torney for health care. The patient designates a primary and secondary person to make decisions for them when they are unable to do so. They may name their spouse, other family members, or a friend. The patient chooses an alternate in case the person they chose is unable to fulfill his or her role. An AD allows the patient to put into writing their wishes about medical treatments for the end-of-life (EOL) care. It can be used as a guide for family members, loved ones, and medical providers to make decisions about treatments according to the patient’s wishes. The Utah AD is a legal document that is signed by the competent individual and a witness. It does not need to be notarized or signed by a lawyer but can only be completed by the patient when they have full capacity to make decisions. If they are unconscious and no one has been docum nted as the medical POA, then Utah law says the medical provider can talk to the spouse, adult children, a parent or grandparent. This document is not a medical order but a guide when the patient gets to the hospital. The patient may end up in the ICU on a ventilator, feeding tubes, and central lines with heroic efforts being made before the patient’s wishes are known. Medicare has ncluded ACP in the Annual Welln ss Visit (AWV). If physi- cians take the time during the AWV, they can bill for ACP (99497 for the first 16 to 30 minutes, at a cost of $85.93, and 99498 for each additional 30 minut s at a cost of $74.83). How Can We Improve Our ACP in Utah? We need to make this conversation less about death and more about planning for an emergency. Utah excels in emergency preparedness when it comes to disaster preparedness. As family physicians, we need to help patients understand that this kind of emergency preparedness is just as im- portant, if not more so. For links to the forms mentioned in this article and oth useful w bsites t help you st rt talking with your patients about end-of-life options, visit utahafp.org/ACP for information. Dr. Collett is the Chair of Utah POLST Registry, Utah Representative on National POLST, and Faculty at St. Mark’s Family Medicine Residency. Advance Care Planning | Continued from page 33 www.UtahAFP.org | 34