February 12, 2015

Who should have the difficult discussion of the goals of care with Anne, a 59-year-old woman with advanced illness?

This is the conversation prompt beneath a case vignette published Feb. 11 by the New England Journal of Medicine. Susan Tolle, M.D., professor of medicine, OHSU School of Medicine, was invited to write an essay in response, discussing who should lead conversations with patients about their choices when facing advanced illness or frailty.

Dr. Tolle makes the case that patients and families need support and argues for primary care physicians to lead the conversations and provide support. “Having conversations about the goals of care earlier in the course of an illness often affects satisfaction and the choices patients make,” wrote Dr. Tolle.

She suggests that when the patient is ready to turn their wishes into action that Physician Orders for Life-Sustaining Treatment (POLST) Paradigm, should be used to help guide the conversation. Dr. Tolle is director of the OHSU Center for Ethics in Health Care and is one of the founders of the POLST movement. Read Dr. Tolle’s piece and contribute to the ongoing conversation on the NEJM website.

An elective course in the School of Medicine M.D. program helps teach future physicians how to have “goals of care” conversations with seriously ill patients. Lynne Booth, first-year medical student, wrote “Let’s Talk about Death” on OHSU StudentSpeak in response to her experience in the Living With Life Threatening Illness class.

Media coverage of Dr. Tolle’s essay includes The Oregonian and the Portland Business Journal.

Related reading

• Proof of POLST – School of Medicine paper of the month, July 2014
• Dr. Susan Tolle awarded prestigious MacLean Center Prize
• The Trouble With Advance Directives (New York Times)