Support for a Standard Operating Procedure for the Use of Medical Orders for Life Sustaining Treatment (MOLST) Forms in a Comprehensive Cancer Center
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Problem under investigation: For adult palliative care patients at a Comprehensive Cancer Center, how did having an active Medical Orders for Life Sustaining Treatment (MOLST) form affect advance-care planning? Under this same service, how did having an active MOLST form impact the care provided by the palliative care team? Objective: Provide support for MOLST forms which enhance patient- and family-informed care regarding end-of-life orders at a Comprehensive Cancer Center. Background literature and theoretical framework: As of 2008, a MOLST form must be accepted and recognized as the legal equivalent of a do-not-resuscitate (DNR) form in New York State. The MOLST conveys the patient’s end-of-life wishes beyond resuscitation and intubation. However, it remains largely underutilized. The framework is supported by Ruland’s Peaceful End of Life Theory that developed a standard for care provided at end of life. Project Methods: Qualitative thematic analysis conducted via interviews with both the palliative care team and adult patients admitted to the inpatient palliative service. Results: Patients and palliative care providers expressed feelings of obligation in completing patients’ MOLST forms in an abbreviated period of time to avoid life-saving measures. Potential Significance: Aid in the development of a standardized operating procedure for the use of MOLST in the healthcare setting. Implications: Introducing the MOLST form prior to an inpatient admission alleviates making compulsory end-of- life care decisions. With a standardized approach, MOLST forms can enter a patient’s care at a time that allows for collaboration with their physician, overall enhancing patient-informed care and improving quality of life at end of life.