Serious Illness- MOLST Challenge Timeline

What's MOLST?

MOLST or Medical Orders for Life-Sustaining Treatment is a powerful health care planning tool and a medical order for adults who are frail or diagnosed with a serious advancing illness. Clinicians and patients talk about the adult's current medical condition, prognosis and possible treatment options, including the benefits and risks of attempting life-sustaining treatments. Adults choose treatment options that align with their values and priorities to live well with their serious illness, and record their choices for life-sustaining treatments in the MOLST form. A MOLST form is voluntary,and can be updated and revised as a patient's health needs and choices may change overtime. A licensed health care provider shouldhonor the form in all care settings.

What's Our Serious-Illness- MA MOLST Challenge?

Adults, families and caregivers will meet many clinicians and care providers on their serious illness journey. Our challenge is to build a collaborative process that is responsive to an adult's changing health needs and care choices at every phase of theri journey, whether first diagnosed through to end of life care.  The Medical Orders for Life- Sustaining Treatment or MOLST form and process is an important part of the serious illness journey. Its a medical order completed by the atient and clincians which  to communicates  a patients choices for care. Honoring Choices Partners, state agencies, health systems, community organizations, and consumers are all working to strengthen and re-design our Serious-illness- MA MOLST process to provide high quality, person-directed care.

Progress to Date The timeline shows the collaborative progress taking place in Massachusetts and on a national level as we join the National POLST Paradigm.  We welcome knowing about your work, studies and tools. Email  Ellen, edipaola@honoringchoicesmass.com.

June 2019 — National POLST Education Committee designs tools for patients & providers.

Ellen DiPaola, Esq., member of the National POLST Education Committee and Honoring Choices President & CEO, is working with multi disciplinary care professionals from across the country to build a more robust POLST/MOLST serious illness education program at the national level. Working together. the committee will:

  • identify a national standard to know and honor the care choices of adults with serious advancing illness;
  • assemble informational fact sheets, videos, webinars for more effective patient-provider conversations;
  • make all materials free and downloadable for Massachusetts patients and providers. The current tools are available here.

May 2019 — DPH MOLST Advisory Group Reviews the National POLST Form Draft

The DPH MOLST Advisory Group has been working diligently with the National POLST Paradigm (NPP) to contribute to a new 50-state National POLST/MOLST form and implementation process.  If adopted by Massachusetts, it will greatly standardize and improve our MOLST process for all stakeholders- health systems, community groups, and the Probate & Family Court. The final version of the new National POLST/MOLST form will be released in August. Our MOLST Advisory Group will re-convene to review. Keep you posted!

May 2019 — First National Plenary Assembly Summit

Christine Michael, member of the National POLST Plenary Assembly and  Executive Directiver of Hospice & Palliative Care Federation of MA, helped organize and the first meeting of representatives from 45 states in Austin Texas,  to work on a national standard for POLST/MOLST.

December 2018 — DPH Palliative Care & Quality of Life Advisory Council recommends MA MOLST Report

We took our first big step to re-design MA MOLST Process to be   “conversation based, team oriented process in compliance with the National POLST Paradigm (NPP).”  On Nov. 30, 2018 the MA MOLST Advisory Group, a committee of the Palliative Care & Quality of Life Interdisciplinary Advisory Council, unanimously voted to advance our "MA MOLST Program Key Elements & Standards Reports" to the full Palliative Care & Quality of Life Advisory Council. The full council  unanimously voted to make a formal recommendation to  Department of Public Health to accept the report to allow the MA MOLST Advisory Group to take next steps. Lachlan Forrow, MD, Chair, (pictured here) forwarded the report to Dr. Elizabeth Chen, Associate Commissioner, who responded favorable to the report.

June 2018 — Honoring Choices Guardianship-MOLST Advisory Group convenes

Father seated. Daughter hugging him from behind.The DPH MOLST Subcommittee Advisory Group( MOLST Advisory Group)  expands to a 28-member committee to bring in the expertise of a multi-disciplined health care providers and professionals, who represent a wide diversity of adults across the Commonwealth.  Our charge from Dept of Public Health (DPH)  who oversees MOLST  is to help Massachusetts come into compliance with National POLST Paradigm standard and to create a conversation-based. team approach form and process to help stakeholders across all care settings know and honor an adult's choices for care. The MOLST Advisory Group. members are:

May 2018 — Expanded 28 Member MOLST Advisory Group gets to work!

The DPH MOLST Subcommittee Advisory Group( MOLST Advisory Group)  expands to a 28-member committee to bring in the expertise of a multi-disciplined health care providers and professionals, who represent a wide diversity of adults across the Commonwealth.  Our charge from Dept of Public Health (DPH)  who oversees MOLST  is to help Massachusetts come into compliance with National POLST Paradigm standard and to create a conversation-based. team approach form and process to help stakeholders across all care settings know and honor an adult's choices for care. The MOLST Advisory Group. members are:

February, 2018 "EMS & MOLST: 5 Things You Can Do Ahead of an Emergency"

The 5 MA Emergency Medical Services (EMS) Regional Directors worked closely with Honoring Choices Partners & friends to create 5 important things we can all do to help ensure a medical order is valid, visible and can be honored in a medical emergency.Many thanks to Mark J. Miller, former Director, OEMS, and the 5 Regional EMS Directors who spoke with hundreds of care providers across the Commonwealth to create this simple guide for high quality, smoother care transitions.

Read more and download the free guide here.

 

January 1, 2018 New Study: "Engaging Key Stakeholders To Improve the MOLST Process."

Over 450 interdisciplinary care providers gathered in 9 Honoring Choices MOLST Workshops across the Commonwealth from April through December 2017, to discuss MOLST best practices and implementation challenges. Data from the 358 comprehensive surveys from the attendees is now being analyzed to discover common themes and solutions to improve the delivery of serious illness care and MOLST. The study is led by Susan DeSanto-Madeya, PhD, RN, Associate Clinical Professor, Boston College, Wm. F. Connell School of Nursing. The results will be available by May 2018. Download tools and webinars from the MOLST workshops.

May 2017 —Governor Baker announces Massachusetts will join the National POLST Paradiym

The DPH MOLST Advisory Group has been working diligently with the National POLST Paradigm (NPP) to contribute to a new 50-state National POLST/MOLST form and implementation process.  If adopted by Massachusetts, it will greatly standardize and improve our MOLST process for all stakeholders- health systems, community groups, and the Probate & Family Court. The final version of the new National POLST/MOLST form will be released in August. Our MOLST Advisory Group will re-convene to review. Keep you posted!

April- November 2017 — Honoring Choices launces six "MOLST: Meeting the Challenge" Workshops

MOLST Workshop Panelists posed photoHonoring Choices launches a series of workshop across the Commonwealth to design a high-quality responsive process for adults with living with serious advancing illness. Each co-hosted workshop brought together 50-100 multidisciplinary care providers and community professionals to focus on serious illness and opening meaningful conversation using the MA MOLST  form, and delivering timely person-directed coordinated care. We listened carefully to their concerns shared about the current MOLST process and the barriers and challenges to delivering quality care. The groups discussed best practices and next steps in creating a high quality process. A survey was completed- results available shortly. Here's the list of workshops: 

  • Metrowest & North Shore: April 24; Co-hosts the Massachusetts Medical Society (pictured here)
  • Cape Cod & Islands: June 1; Co-hosts Cape Cod Healthcare
  • Springfield & Western MA; September 19; Co-hosts Baystate Health
  • South Shore: October 25; Co-hosts Hawthorn Medical Associates, Dartmouth
  • Worcester & Central MA; October 18; Co-hosts Worcester Community Partners
  • Worcester & Central MA: November 15; Co-hosts UMass Memorial Medical School

 

May 9, 2017— Taking Steps to Join the National POLST Paradigm

National POLST Paradigm logoThe Massachusetts Department of Public Health, who oversees the MOLST process, is taking steps to join the national patient-directed serious illness initiative. The National POLST Paradigm was established in 2004 to establish national quality standards for POLST / MOLST Paradigm Programs, and to assist states in developing their programs. They have a extensive website of evidence based research, webinars, tool kits and more. Joining National POLST will offer Massachusetts a well-established, evidence based model to consider for crafting our state program.  Secretary Alice Bonner, MA Executive Office of Elder Affairs announced the news at the May 9 MA Coalition for Serious Illness Care's Annual Meeting.

Read more about National POLST Paradigm

To Access Tool Kits and Webinars. Click Here

June 2017 - Honoring Choices introduces Palliative Care Discussion Guides

Image of Who's Your Agent Program Palliative Care Discussion GuideDoctors and care providers consistently agree starting a "MOLST discussion" with a patient at first diagnosis is a "best practice."  The discussion allows patients to: 1. Understand their prognosis and treatment options to create goals of care; 2. make choices about life-sustaining treatments; and 3. explore palliative care to manage the pain, symptoms and stress of serious illness. Honoring Choices is pleased to offer our new Palliative Care webpage with two free, downloadable discussion guides:

 • "5 Things To Talk About With Your Care Providers"; a handy guide for consumers; and

"5 Things To Talk About With Your Patients & Clients"; a handy  guide for providers.

Read More about Palliative Care  Discussion Guides here.

June 2017 - Working with the Court: Guardians Authority to Sign a MOLST Form

Massachusetts Court System logOn June 8, Honoring Choices was invited to provide a update on MOLST to the Guardianship Committee of the Probate and Family Court. Ellen M. DiPaola, Esq., President & CEO, provided a status report to the Guardianship Committee's Judges and Assistant Judicial Case Managers who oversee guardianship petitions and a guardian's request for permission to sign a MOLST form.  The court is considered "a major stakeholder" in helping to safeguard and improve the serious illness journey for an incapacitated person, and to support a Guardian's role/responsibility to protect the rights of an incapacitated person and provide for essential care. We had a thoughtful discussion regarding the opportunity to improve the MOLST form, and align court protocols and procedures with fellow medical and community care stakeholders. The Honoring Choices Work Group will explore the Committee's suggestions and report back for further discussion.

December 2016 — DPH Palliative Care & Quality of Care Advisory Council recommends joining National POLST Paradiym

The DPH MOLST Advisory Group has been working diligently with the National POLST Paradigm (NPP) to contribute to a new 50-state National POLST/MOLST form and implementation process.  If adopted by Massachusetts, it will greatly standardize and improve our MOLST process for all stakeholders- health systems, community groups, and the Probate & Family Court. The final version of the new National POLST/MOLST form will be released in August. Our MOLST Advisory Group will re-convene to review. Keep you posted!