IL Dept. of Public Health issues report on the feasibility of a statewide POLST/Advanced Directives electronic registry.

Two members of the POLST Illinois Committee recently collaborated with 10 other organizations on the Illinois POLST and Advance Directives Registry advisory committee. The committee, representing various stakeholders for POLST and end-of-life care issues, assisted the Illinois Department of Public Health in drafting a report required under a law passed in 2018. The report proposed necessary capabilities for a limited statewide registry of POLST forms, described potential challenges to its feasibility, and suggested ways to improve its viability. The committee and state agency concluded that a proposed statewide registry for POLST forms is a feasible endeavor for Illinois if the state initially limits registry capabilities and content to solely POLST forms and pursues a public-private partnership to fund the registry using existing technology procured from a third-party vendor. The committee recommended next steps to put Illinois in the best position possible to implement the statewide POLST registry, including further defining the system, obtaining rough capital and operating cost estimates, and exploring partnerships with external stakeholders to assist in running the system. The IL Department of Public Health stated that developing the proposed statewide registry will prove a challenge but one the state can overcome in collaboration with the right partners.

New Legislation in Illinois would improve access to POLST for seriously ill people.

People facing a serious, life-limiting illness have the right to control the use of life-sustaining treatments and should not experience barriers to documenting their decisions or having their preferences honored by their healthcare providers. A bill in the IL General Assembly sponsored by Senator Sara Feigenholtz, Democrat from Illinois’s 6th District in Chicago, would help make it easier for health care providers and patients to participate in the POLST model.

Additionally, this legislation would allow medical providers, long-tern care facilities and EMS/first responders to honor the National POLST form and forms used in other states when people travel to Illinois. Portability and reciprocity of POLST forms better assure the honoring of a patient’s wishes in our increasingly mobile society. The success of the POLST Illinois program benefits when national and other state programs share the same vision, adoption, and implementation to support seriously ill or frail individuals wanting to participate in the POLST model. Building in a presumption of validity in good faith for POLST forms signed by the patient or their appropriate substitute decision maker (SDM), regardless of the state or National form used protects EMS providers, medical providers, and health care facilities while supporting the delivery of care concordant with the patient’s expressed preferences.

Language Accessibility Means More Inclusive Use of POLST for People Whose Native Language is Not English.

The POLST IL C ommittee worked with the Illinois Department of Public Health (IDPH) to update the IL POLST form, in 2022. Following this update, IDPH produced translated versions of the updated form. The translated versions are identical to the English version.

To fulfill the mission of providing seriously ill people with all the care they need but only the care they want to receive, it is critical to understand and utilize best practices for using translated versions of the IDPH Uniform POLST form.

Using the IDPH POLST Form with non-English speakers.

As a matter of justice, all individuals should be afforded the same access to POLST, regardless of their native language. To this end, health care translation services should be used when the patient and/or family/surrogate is discussing POLST and has limited English proficiency.

The IDPH POLST form is available in some languages other than English (see the Illinois Department of Public Health – Advance Directives webpage for up-to-date list). Translated versions are 4 pages total (2 double-sided pages) in length. The front sides of the pages are in the non-English language while the corresponding back sides of the pages are in English. The non-English language sides are for educational purposes only. The POLST form should be completed, signed, and displayed in English so that emergency medical personnel can understand and follow the orders.

Qualified health care practitioners executing a POLST with a patient are strongly encouraged to document in the medical record the content of their POLST conversation with the patient or their representative, indicating that 1.) the conversation occurred in the patient's or representative's native language and 2.) the patient or their representative demonstrated understanding of the orders being selected on the form.

To ensure that the English version of a person’s IDPH Uniform POLST form is the one presented to Emergency Medical Services (EMS) personnel, The POLST IL committee worked with IDPH to add a watermark stating the translated version is for educational purposes only and instructs users to complete the English version. For additional protection, a visual block over the signature sections of the translated version is present. Both the English version and the translated version are presented together on a 2-page, double-sided document.