New Jersey doctor creates online patient resource to improve end-of-life care



    A New Jersey doctor has created a new tool to help patients and doctors fill out POLST forms. That’s short for Practitioner Orders for Life-Sustaining Treatment. Without it, Dr. David Barile said, patients at the end stages of life may get too much of the wrong kind of care.

    Health care can be really fragmented, and that’s making it harder for patients at the end stages of life to reach the best decisions about their care, according to Barile, a geriatrician in Princeton.

    “The patient or surrogate is encountering new doctors all the time, and we’ve created a situation where we have strangers taking care of strangers in the hospital setting,” Barile said.

    It results in a lot of unwanted care.

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    Doctors are often trained to treat and to cure, he explained, but that might not always lead to the best outcome. Patients, meanwhile, may not understand their prognosis, or best-case scenario for the future, and therefore make decisions that are not based in reality.

    Barile directs the nonprofit New Jersey Goals of Care, and he recently made a free online video series he hopes will change this.

    You can view it here.

    It’s pretty short and bland, but it does clearly go through the importance of a POLST form and how to fill it out. Barelle said he thinks this can make the world of difference for patients in identifying and getting the therapies that best match their goals.

    “This POLST form is an actionable medical order that, by law, if it says do not send a patient back to hospital, then you should try to avoid rehospitalization, if it says do not put a feeding tube in, then you should not put a feeding tube in. No resuscitation? Then no resuscitation,” he explained. “And it can say the opposite, too.”

    Barbara Fox has seen the positive impact first hand.

    “By the time you get to that point in the illness, it’s an emotional roller coaster,” she said.

    Years ago, Fox cared for her mother, who didn’t have the form. More recently, she cared for a loved one who did.

    “Both the patient and care manager are at sixes and sevens not knowing what to do, and the POLST form is a blessing,” she said. “It’s a framework for going through step by step what you really do need to think about.”

    And the more prepared patients are with these forms, Barile said, the more success they’ll have in discussing their wishes and seeing them through in a medical setting.

    Because, he said, even doctors struggle with these conversations.

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