POLST Evidence and Update: Kelly Vranas, Abby Dotson, Karl Steinberg, and Scott Halpern
episode
GeriPal - A Geriatrics and Palliative Medicine Podcast
52 min
3 speakers
8 chapters
transcribed 8 hours ago
Transcript
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Transcript generated automatically by AI and may contain errors.
What is POLST and why has its name changed over time?
Welcome to the Jerry Pal podcast. This is Eric Rudera.
This is Alex Smith. And Alex Full House today again. We have a full house today. We're delighted to welcome Kelly. Vranus, did I say it right? Close, Varanus.
Yep.
Well that rehearsed good now. Thank you for correcting me. She's Associate Professor of Medicine, Pulmonary and Critical Care at Oregon Health Sciences University. Welcome to the Jerry Powell Podcast, Kelly.
Thank you so much.
All right, and Abby Dotson, who is a research assistant professor of emergency medicine, also at OHSU, an executive director of National Pulse and Director of the Oregon Pulse Registry. Welcome Abby.
Thanks for having me.
And we're delighted to welcome back Carl Steinberg, who is the palliative care doc. He's a geriatrician. He's been a hospice and nursing home director. He's president of National Pulst and recent past president of AMDA, the sort of long term care association. Welcome, Carl.
Thanks for having me. Hey, it's National Pulsed Collaborative now. We changed our name. So National
Pulse Collaborative. Thank you. Great. Good to know. And Scott Helburn, who is professor of medicine, medical ethics and health policy, and director of the Palliative and Advanced Illness Research Center or Pair Center at the University of Pennsylvania and professional Uber driver for his daughter's softball games. Scott, welcome back to Jerry Powell.
Great to see uh We're gonna be talking about all things pulled, but before we talk about that subject. I think somebody has a song request. Is it you, Carl?
Yep, it's me. And the song is No Hard Feelings by the Avet brothers.
Now Carl, uh why did you choose this song?
Oh gosh, how long do you have? I mean, just beyond the literal end of life, what happens when we die stuff. I mean, there's just so much more. It's like how liberating it is to eliminate resentments, regrets, and envy from our lives, and how great it is in our clinical practice when we're able to help families reconcile after an estrangement, you know, how much relief that brings. Uh, there's an old 12-step uh thing about like harboring a Resentment is like swallowing poison and then waiting for the other person to die. And just, you know, similar to death, right before death, before we go to sleep every night, you know, it's just such a relief to not be consumed with anger and to sort of have no enemies.
And in the context of a friendly. point counterpoint that we may be having today, that ultimately we we're not enemies. We all agree, I think, that we want people to get gold, concord, and care. Anyway, sorry. That's lovely. That's great. Great setup.
When my body won't. Hold me anymore and it finally Let's be free. Will I be ready? When my feet won. Walking at the mire and my lips give their light. Qu'est-ce que bah Will my hands be steady? When I lay down my fears, my hopes and my doubts. The rings on my fingers and the keys to my house. But no Heart feelings, Lord knows they have done. Much good for anyone. Kept me afraid and cold. With so much to have and hold.
That is a beautiful song. Great choice, Carl. Thank you. So uh let's let's jump into it. Physicians orders for life sustaining treatment. I think some places call it a little bit different. Carl For our audience, can you just give us a brief description what Polst is?
Sure. And and uh have to correct you again. It's no longer physician orders for life sustaining treatment. Uh although that is still in the statute in some states, including California, but we've we've moved away from that term, uh, you know, that long thing, because it's not always physician orders, number one. And then the whole notion that life sustaining treatment is a little value laden, like doing CPR on a 68-pound So uh now it's just pulsed, the word pulsed, uh portable medical orders, right? So uh it's not an acronym anymore. Right. It's it's well, we're trying to move away from that. Right. And so you're right.
How do the experts describe the current evidence base for POLST?
There's like, believe it or not, I think there's 13 different names for Pulsed Paradigm type forms. My favorite is T pop, uh, but uh sounds like some kind of, you know, hip hop thing.
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Chapters
8 chapters
1
What is POLST and why has its name changed over time?
0:00–5:03
2
How do the experts describe the current evidence base for POLST?
5:03–12:17
3
What did the systematic review of 105,000 patients reveal about POLST’s impact on treatment intensity?
12:17–19:41
4
Why do some clinicians argue that POLST’s effect may be due to underlying patient preferences rather than the form itself?
19:41–26:56
5
How do discrepancies between POLST orders and actual care arise in acute and nursing‑home settings?
26:56–33:38
6
What are the arguments for and against using POLST as a quality‑metric or mandatory requirement?
33:38–38:51
7
How could a national POLST registry and standardized data improve research and clinical use?
38:51–45:36
8
If you had a magic wand, what single change would most improve POLST implementation and outcomes?
45:36–52:00
Speakers
3 identifiedMore from GeriPal - A Geriatrics and Palliative Medicine Podcast
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