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Physician order for scope of treatment (POST) in South Carolina (SC).

21 Background: Physician Order for Life-Sustaining Treatment (POLST, www.POLST.org ) is a process and tool that translates patients' goals of care into medical orders in a highly visible, portable way. Trained providers meet with seriously ill patients (or the surrogates) and discuss the available treatment options in light of their current condition, and help clarify the patient's preferences. The physician then documents those preferences on a standardized medical order form, which travels with the patient if he or she changes settings of care. The POLST form is 1. a physician order, 2. signed by the patient, 3. after consultation with the physician, 4. facilitated by a person trained in advance care planning, 5. directed toward people with serious, chronic illness such that death in the next year would not be a surprise, 6. addressing the decision at a moment of medical crisis to a. hospitalize with full therapeutic intervention, or b. hospitalize with limited therapeutic intervention (such as no CPR), or c. provide supportive, palliative care in the present setting (home or nursing facility), 1. addressing further decisions such as feeding tube, parenteral (IV) hydration, or antibiotics, 2. documented in a widely publicized, recognized and understood form with a distinct pink color, and 3. accepted by EMS responders, hospices, nursing facilities, and hospitals across the state.


METHODS
The SC Coalition for the Care of the Seriously Ill is comprised of clinical and administrative leaders representing key statewide organizational partners, healthcare entities, and individuals. The Coalition proposes a template order for statewide integration to be called POST. The target population is persons with serious illness for whom death in the next year would "not be a surprise."


RESULTS
Presently, the Coalition is working with state government to undertake a three-county pilot study of POST. Challenges include creating a legal framework, IRB approval, and education of providers and the public.


CONCLUSIONS
POST may facilitate patient-centered advanced cancer care. Implementation of the POST in SC will require collaboration by stakeholders. Collaboration will require responsiveness to constituents' concerns in order to facilitate patient-centered care.