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End of Life Care

Selected Research Projects

Retirement Research Foundation
PI: Susan Tolle, MD
"Cross-State Collaboration: Mentoring National Development of POLST"
The goal of this project is to mentor state POLST coalitions to move as many as possible from their current status to the next level of development.

California HealthCare Foundation
PI: Susan Tolle, MD
"Cross-State Collaboration: Mentoring National Development of POLST"
The goal of this project is to ensure that the wishes to have or to limit treatment of individuals with advanced illness or frailty are more consistently respected.

The Kinsman Foundation, Oregon
PI: Susan Tolle, MD; Co-PI: Erik Fromme, MD
Changing and Disseminating Health Policies: Defending Comfort and Dignity in Oregon's Nursing HomesThe major goal of this project is to focus on policy development, training, systems, review, collaboration and dissemination in Oregon's Nursing Homes.

Oregon Community Foundation
PI: Susan Tolle, MD
The major goal of this project is to expand the availability and quality of the Physician Orders for Life-Sustaining Treatment education and training materials.

The Kinsman Foundation, Oregon
PI: Susan Tolle, MD; Co-PI: Erik Fromme, MD
Promoting palliative care in smaller and rural hospitalsThe major goal of this project is to support the growth of inpatient palliative care in Oregon hospitals.

The Greenwall Foundation
PI: Susan Tolle, MD
"Building a Model Electronic POLST Paradigm Registry: Honoring Patient's Preferences in End-of-Life Care"
The purpose of this grant is to build and test a new statewide electronic Registry   

Archstone Foundation
PI: Susan Tolle, MD
POLST production of Spanish POLST DVD"Honoring the Wishes of the Spanish Speaking Patient" for dissemination in Oregon and SW Washington

Converting Treatment Wishes into Orders at End of Life
PI: Susan Hickman, PhD, OHSU; Co-Investigators: Susan Tolle, MD, OHSU; Alvin Moss, MD, West Virginia University;  Bernard Hammes, PhD, Gunderson Lutheran Medical Center.
Federally-funded multi-state study is examining the use of the POLST (Physician's Orders for Life-Sustaining Treatment) in nursing facilities in the states of Oregon, West Virginia, and Wisconsin. 

Selected Papers

  1. Fromme, EK, Zive, D, Schmidt, TA, Olszewski, E, Tolle, SW, POLST Registry Do-Not-Resuscitate Orders and Other Patient Treatment Preferences. JAMA 2012, 307(1): 34-35
  2. Fromme, EK, Stewart, TL, Jeppesen, M, Tolle, SW. Adverse Experiences With Implantable Defibrillators in Oregon Hospices Am J Hospital Palliative Care August 2011 28: 304-309
  3. Hickman SE, Nelson CA, Moss AH, Tolle SW, Perrin NA, Hammes BJ. The Consistency Between Treatments Provided to Nursing Facility Residents and Orders on the Physician Orders for Life-Sustaining Treatment Form. Journal of the American Geriatrics Society. 2011: Article first published online: 22 OCT 2011, DOI: 10.1111/j.1532-5415.2011.03656.x
  4. Fromme  E.K., Smith M.D., Bascom, P.B., Kenworthy-Heinige, T., Lyons K.S., Tolle S.W.,  "Incorporating Routine Survival Prediction in a US Hospital Based Palliative Care Service" J Palliat Med 2010, 13(12) 1439-1444
  5. Hickman, S, Nelson C, Perrin N, Moss A, Hammes B, Tolle S. "A Comparison of Methods to Communicate Treatment Preferences in Nursing Facilities: Traditional Practices Versus the Physician Orders for Life-Sustaining Treatment Program." Journal of the American Geriatrics Society 2010 58(7): 1241-1248.
  6. Hickman S, Nelson C, Moss A, Hammes B, Terwillger, A, Jackson A, Tolle . Use of the Physician Orders for Life Sustaining Treatment (POLST) Paradigm Program in Hospice Setting. J Palliat Med 2009; 133-141
  7. Dunn PM, Tolle SW, Moss AH, Black J.  The POLST Paradigm: Respecting the Wishes of Patients and Families. Annals of Long-Term Care 2007; 15(9):33-40
  8. Fromme EK, Bascom PE, Hansen LI, Smith MD, Osborne MO, Tolle SW. Survival, mortality, and location of death for patients seen by a hospital-based palliative care team. J Palliat Med 2006.
  9. Schmidt TA, Hickman SE, Tolle SW, Brooks HS. The Physician Orders for Life-Sustaining Treatment program: Oregon emergency medical technicians' practical experiences and attitudes. J Am Geriatr Soc 2004; 52(9):1430-1434
  10. Hickman, SE Tolle, S.T., Brummel-Smith, K., & Carley, MM . Use of the Physician Orders for Life-Sustaining Treatment Program in Oregon nursing facilities: beyond resuscitation status. Journal of the American Geriatrics Society 2004; 52(9):1424-1429
  11. Tolle SW, Tilden VP. Changing end-of-life planning: the Oregon experience. J Palliat Med 2002; 5(2):311-317.
  12. Tilden VP, Nelson CA, Dunn PM, Donius M, Tolle SW. Nursing's perspective on improving communication about nursing home residents' preferences for medical treatments at end of life. Nursing Outlook 2000 (June); 48(3):109-115
  13. Tilden VP, Tolle SW, Nelson CA, et al. Family decision-making in forgoing life-extending treatments. J Family Nurs 1999; 5(4):426-442.
  14. Tolle SW, Tilden VP, Nelson CA, Dunn PM. A prospective study of the efficacy of the physician order form for life-sustaining treatment. J Am Geriatr Soc 1998; 46:1097-1102 

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