ALIGNING CHOICE AND CARE PROVISION
The DMOST form is the end-product of communication between a patient and/or their authorized representative, and their medical practitioner. This communication ensures informed medical decisionmaking and the honoring of a patient’s preferences regarding life-sustaining medical procedures such as cardiopulmonary resuscitation (CPR). The DMOST form is a single, standardized document that functions as an actionable medical order and is portable through all health care settings. The DMOST form and program are based on recommendations from the National Physician Orders for Life Sustaining Treatment (POLST) program: the form and online training module can be found at delawaremost.org. In 2017, significant progress was made towards the goal of educating and informing both the professionals and the public in the state of Delaware. Over 2,800 pink DMOST envelopes were requested in 2017 for use in private offices and acute care settings. Additionally, the Delaware Health Information Network (DHIN) entered into a contract with VYNCA to implement an electronic DMOST registry and electronic version of the DMOST form. There were 130 learners utilizing the online training module in 2017, and 301 learners attended live training sessions. When added to the 489 people trained on the DMOST form in 2016 (342 online and 147 live), a total of 920 people have been trained on the DMOST form since its inception. Thirty-eight people took additional training to allow them to train others on the DMOST form and procedures. Each facility is responsible for developing a DMOST policy that works best with their current standard of practice. These policies refer to EHRs, DMOST education and accountability, and the updating and integrating of DMOST forms. The DHIN began implementing an electronic registry with the help of VYNCA, a corporation that has successfully implemented similar online Advance Directive and POLST registries in other states. In order to more accurately match patients, the DMOST form was updated to include more demographic information. At the same time, Section E was reworded to clearly allow patients to allow or dis-allow their authorized representative to change their DMOST form if the patient loses capacity (Figure 2). The DMOST program manager will continue to work with both DHIN and VYNCA to train users throughout the state on the e-Registry and e-Form as they become available. Once the registry and e-Forms are available to healthcare providers, previously completed paper forms will be scanned and uploaded. The DMOST form helps individual professionals trained in its use to honor a patient’s end-of-life decisions, but more training and education is needed to get all healthcare facilities in Delaware to take up the effort. Education on the form will also continue for the public – both patients and caretakers alike – to allow for quality end-of-life discussions and clear instructions for a patient’s goals of care. All of the many stakeholders of this program have expressed their approval of the DMOST program as a tool for increasing provider/patient communication, standardizing end-of-life treatment options, and giving patients more control over their final wishes. There are barriers to the use of the DMOST form throughout the state, especially concerning the education about and training on the use of the DMOST form. With ongoing training in both the professional and public sectors, and the upload of the DMOST form to the DHIN, these barriers may no longer be an issue, and many more citizens of Delaware may be able to use the DMOST form to guide and standardize their end-of-life treatment decisions.