Which types of health professionals should talk to patients about MOLST decisions?
Discussions with patients and families about life-sustaining treatment decisions that may be documented on a MOLST form are clinical discussions, to be conducted by a physician, nurse practitioner or physician assistant.
When suitable, based on the patient's current medical condition, all physicians, nurse practitioners or physician assistants—regardless of setting of care, specialty or length of relationship with the patient, should talk about advance care planning with patients and document patients’ treatment preferences. Such conversations may include discussing and/or filling out a MOLST form.
Other health professionals (e.g. nurses or social workers) may discuss advance care planning and MOLST with patients; however, discussions that involve medical treatment decisions to be documented on the MOLST form are considered informed consent conversations and must be conducted by a physician, nurse practitioner or physician assistant.
What is the process for introducing the option of using a MOLST form?
It starts with a person with advanced illness (and/or their caregivers, family members) and health professionals talking about health care planning. This may or may not lead to the person choosing to document decisions about life-sustaining treatment using the MOLST form.
Why shouldn’t blank MOLST forms be given to or mailed to patients or their family members to preview or consider on their own?
The MOLST form is a standardized medical order form that relays instructions from one licensed health professional to another. It should be filled out by a health professional, after discussions between a clinician and patient about the patient's prognosis, treatments and goals of care. The MOLST form should not be used to introduce or solicit patient decisions about life-sustaining treatments. It is designed only for documenting decisions patients make in the context of appropriate discussions about life-sustaining treatment choices with a clinician.
Why does a clinician (physician, nurse practitioner, physician assistant) need to personally engage in these discussions?
Conversations that result in signing a MOLST form must include discussions about the person's health status, prognosis, personal values and goals of care, and the potential benefits and burdens of treatments. These are “informed consent” discussions that must be conducted by a clinician. The clinician signature on the MOLST form attests that the form was filled out to reflect the discussions he or she had with the patient.