Applying the POLST to Children David Brunelle, MD Pediatric Complex Care Support Team

The Pediatric Complex Care Support Team Maximizing Quality of Life through… Education Exploration of Goals of Care Complex Medical Decision-Making Advocacy Pain and Symptom Management Support (Emotional, Psychological, Spiritual) Comfort Therapies

Challenges with Children Multiple (Evolving) Developmental Stages Non- or Minimally-Verbal Unsophisticated and Naïve about the world Incomplete Understanding of Death & Dying Minimal Decision-Making Authority Large Number of Caregivers

The POLST in Pediatrics Patient Preference is difficult to determine Expect to involve several grown-ups Use the POLST as a springboard into crucial conversations Emphasize the mutability of the document Compliance versus Adherence Get copies into the EHR, the diaper bag, and the local fire station 

Proven Outcomes Improved Care Quality Increased Patient Autonomy and Control Improved Patient Compliance Increased Support Person Participation Improved Customer Satisfaction Improved Care Team Well-Being

What A Wonderful Video... Two points of departure for kids: "...ongoing hospital visits versus comfort-only care." "...too healthy for the POLST."