The Good Death – What Health Care Workers Know About Helping Patients Die

MANHASSET, NY — A recent study published in the February issue of Geriatric Nursing measured knowledge and attitudes of healthcare workers treating terminally ill patients. In the study, Hieu Vo, MD, and his team of North Shore University Hospital researchers administered surveys regarding the MOLST program (Medical Orders for Life-Sustaining Treatment) to residents, fellows, social workers, licensed practical nurses, registered nurses and nurse practitioners. The survey was initiated after it became clear that although these state-issued forms are readily available, there is a great deal of variation among nursing homes in implementing the MOLST.

“The MOLST process provides a framework around which physicians can document patient wishes concerning care at end of life” said Howard Guzik, MD, chief of geriatric medicine at North Shore University Hospital. “This is an essential step in ensuring that frail patients with chronic illness receive care that is consistent with their wishes.”

The study anonymously surveyed healthcare workers during regularly scheduled staff meetings at 16 nursing homes. There were 11 questions about experience and knowledge on advanced directives; 11 questions about attitudes; and nine questions about demographics. The survey asked a range of questions to understand what factors influence participation in the MOLST program.

The researchers reported no difference in gender, ethnicity, religion or professional background among the staff in these facilities. But what did emerge was that facilities with low participation rates in the program had employees who were older than those working in facilities where MOLST use was high. They had also been in practice longer and had been employed by the same facility longer.

Not surprisingly, the majority of survey respondents (77 percent) who work in high prevalence MOLST facilities reported that all long-term care residents should participate in the MOLST program, compared to only 37% of respondents from low prevalence facilities.

According to the study, almost half the respondents from facilities where the MOLST program was prevalent reported that residents with MOLST forms had better pain management — a strikingly higher proportion — as compared to only 11.8 percent of respondents from low-prevalence facilities.

“Educational initiatives targeting staff—and the public—regarding the importance of documenting specific advance directives is crucial in improving quality of life at the end of life” said Renee Pekmezaris, PhD, vice president of community health at the North Shore-LIJ Health System, and one of the study investigators. “This study supports a recent multi-state study finding that nursing home patients participating in a program that records their wishes for end-of-life treatment are far less likely to receive unwanted hospitalization and medical interventions than other patients.”

MOLST forms in New York require a physician’s signature to be valid but other health care providers can assist in having that discussion with patients and their families.

About The Feinstein Institute for Medical Research

Headquartered in Manhasset, NY, The Feinstein Institute for Medical Research is home to international scientific leaders in cancer, leukemia, lymphoma, Parkinson’s disease, Alzheimer’s disease, psychiatric disorders, substance abuse, rheumatoid arthritis, lupus, sepsis, inflammatory bowel disease, diabetes, human genetics, neuroimmunology, and medicinal chemistry. Feinstein researchers are developing new drugs and drug targets, and producing results where science meets the patient, annually enrolling some 10,000 subjects into clinical research programs.