The end-of-life care process in Massachusetts is improving through the Medical Orders for Life-Sustaining Treatment (MOLST) program, according to an editorial in the Sept. 28 Boston Globe. The program is a partnership between UMass Medical School and the Massachusetts Department of Public Health.
MOLST, through a standardized form, allows a seriously ill patient to accept or decline common life sustaining treatments that could include cardiopulmonary resuscitation and artificial nutrition. The form is considered a valid medical order, like a prescription, and is followed as a medical order when shared with a licensed health professional.
The editorial said it is encouraging that roughly three-quarters of health care providers surveyed last year have started using the form. The survey was part of a MOLST evaluation conducted by the Center for Health Policy and Research, a unit within UMass Medical School’s Commonwealth Medicine division.
Commonwealth Medicine launched MOLST as a pilot program in Worcester in 2010, one year after the Massachusetts Legislature mandated its creation. The Massachusetts Expert Panel on End of Life Care recommended in 2010 that the program be expanded statewide.
An outreach and education campaign began in 2012. Nearly 1,000 health care institutions, including hospitals, nursing homes, assisted living centers and hospices, throughout the state were notified that MOLST was available. Resources and training on how to honor MOLST directives were offered to staff at those facilities and other medical personnel, including first responders.
The next phase of the program is to implement recommendations that came from an End of Life Summit convened by UMMS and DPH in April. End-of-life and palliative care experts from across the commonwealth reviewed and updated recommendations from the 2010 Expert Panel Report. The updated recommendations include developing a central entity that can coordinate efforts to improve care at the end of life, including informing and educating consumers, supporting the engagement of patients and providers in advance care planning with tools, creating financial system changes to support patient-centered palliative care, and establishing measures to optimize palliative and end of life care.
Read the full Globe editorial here: End-of-life care needs concrete reforms, not sweeping rhetoric
