Medical Orders for Life-Sustaining Treatment

MOLST Procedure for Clinicians

MOLST Procedure for Physicians, Nurse Practitioners, Physician Assistants

MOLST is one possible outcome of clinician-patient discussions about the patient's condition, prognosis, goals for care, and benefits and burdens of treatment. Although these may be difficult discussions for everyone involved, they improve quality of life for patients and bereavement outcomes for families.

Preparation

  • More than one discussion may be needed before initiating the MOLST form.
  • Gather information about the patient, family, medical condition and prognosis.
  • Involve the patient's loved ones, health care agents, clergy, etc. in discussions.

Discussion to Establish Goals of Care and Treatment Preferences

  • Request health care agent contact information.
  • Strongly encourage patients to appoint a health care agent.
  • Inquire about any other advance directives and find out who has copies.
  • Assess patient and family understanding of the medical situation and provide needed information.
  • Explain treatment burdens, benefits and likely outcomes for that patient.
  • Explore patient's expectations and hopes for treatment, especially what he/she would consider as successful outcomes. Clarify what patient means by comments like "I don't want to be a burden," etc.
  • Gently reconcile hopes and expectations with the medical condition, prognosis, likely outcomes, etc.
  • Discuss preferences about life-sustaining treatments (and encourage discussion among loved ones).
  • Emphasize that all patients will be made as comfortable as possible at the end of life, regardless of their life-sustaining treatment choices.

Introducing the MOLST Form

  • Make sure the patient is using MOLST voluntarily.
  • Fill in sections of the MOLST with the patient or health care agent.
  • Verify that the MOLST reflects the patient's treatment preferences as expressed to you.
  • Complete every element in Sections D and E so the form is valid and can be honored.
  • Make a copy for the patient's health record. Send the original MOLST with the patient.
  • Review "Patients and Caregiver Information" with the patient and send it with them.