1. Applying the POLST to Children David Brunelle, MD Pediatric Complex Care Support Team

2. The Pediatric Complex Care Support Team
Maximizing Quality of Life through…
Education
Exploration of Goals of Care
Complex Medical Decision-Making
Advocacy
Pain and Symptom Management
Support (Emotional, Psychological, Spiritual)
Comfort Therapies

3. Challenges with Children
Multiple (Evolving) Developmental Stages
Non- or Minimally-Verbal
Unsophisticated and Naïve about the world
Incomplete Understanding of Death & Dying
Minimal Decision-Making Authority
Large Number of Caregivers

4. The POLST in Pediatrics
Patient Preference is difficult to determine
Expect to involve several grown-ups
Use the POLST as a springboard into crucial conversations
Emphasize the mutability of the document
Compliance versus Adherence
Get copies into the EHR, the diaper bag, and the local fire station 

5. Proven Outcomes Improved Care Quality
Increased Patient Autonomy and Control
Improved Patient Compliance
Increased Support Person Participation
Improved Customer Satisfaction
Improved Care Team Well-Being

6. What A Wonderful Video... Two points of departure for kids:
"...ongoing hospital visits versus comfort-only care."
"...too healthy for the POLST."