Illinois Removes Witness Requirement for POLST Forms

Illinois Gov. J.B. Pritzker (D) has signed into law Senate Bill 109, which removes the witness requirement for terminally ill patients signing a Physician Orders for Life-Sustaining Treatment (POLST) form. The law becomes effective Jan. 1, 2022.

A key component of advance care plans, POLST forms document patient wishes and goals for end-of-life care, as well as name a proxy to make decisions on behalf of the patient should they become unresponsive.

POLST that limit treatment at the end of life correlate with fewer deaths in a hospital, reduced unwanted CPR, as well as reduced overall hospitalizations. POLSTs have also been found to lower the intensive care unit utilization among residents of nursing homes.

Advertisement

“In practice, requiring that witness signature actually has been a barrier to people who want to complete the form. In certain settings, it’s actually a challenge to find a witness, particularly in more remote settings and home settings,” Julie Goldstein, M.D. medical director of Advance Care Planning & Shared Decision-Making in Serious Illness Program at Advocate Aurora Health, told Hospice News. “There’s no other practitioners’ order that we’re aware of that involves a conversation between a patient and their physician or their authorized practitioner that also requires a witness signature.”

Advance care planning is designed to identify patients’ wishes, goals, and desires for their care up to and including the end of life, or if they become unable to communicate or make decisions. Only 14% of patients with serious illnesses have advance care plans, with patients who receive palliative care being the most likely to have one in place.

Some patients have not had their end-of-life wishes honored by their health care provider because they were unable to find a witness, according to Goldstein, who is also chair of the Ethics Committee at Illinois Masonic Medical Center, and chair of the POLST Illinois Committee. The witness requirement can also create complications related to the Health Insurance Portability and Accountability Act.

Advertisement

The law has implications for hospice and palliative care providers in Illinois.

“Hospice and palliative care providers are often the ones that are stewarding the process of decision-making around end-of life-care for their patients,” Goldstein said. “They are often involved in the challenge of finding a witness. This [legislation] is of great benefit to hospices and palliative care providers who are trying to do the right thing by their patients.”

Goldstein told Hospice News that she and her colleagues support a patients’ right to have an advocate or to involve family or loved ones in the conversation if they so choose.

Payers, health care providers and policymakers increasingly have been recognizing the importance of advance care planning in ensuring patients receive goal-concordant care, as well as potential cost savings, as patients indicate they would prefer lower-acuity care at the end of life, such as hospice. 

Advance care plans can reduce hospitalizations by as much as 26%, reduce health care costs, increase community-based palliative care and hospice utilization, as well as significantly increase the likelihood that care will be delivered in accordance with the patient’s wishes.

While POLSTs are an effective means of making a patients’ wishes known, the forms are not a guarantee of goal-concordant care. Close to 40% of patients in a recent study received end-of-life services in an intensive care unit, contrary to their wishes as documented in a POLST.

Patients and families must be vigilant in making sure their providers are aware of the POLST and that those documents are accessible, potentially at a moment’s notice in the event of a medical emergency. 

“The most tried and true way is to have that document on your person. If you have a fully completed document, and you’re going to the emergency room, carry that document with you if it is at all possible,” Goldstein said.  “Every health care organization has a different way of tracking these kinds of forums internally. In the future, there may be statewide registries in Illinois. There are certainly statewide registries in other states.”

Companies featured in this article:

,