Commentary: Honoring Patients’ Wishes

Commentary: Honoring Patients’ Wishes

November is National Hospice and Palliative Care Month, and we encourage Virginians to be more aware of the innovative and compassionate end-of-life care available throughout the Commonwealth.

Capital Caring — a non-profit, community-based, hospice and palliative care organization — was founded in 1977 and is one of the oldest and most experienced non-profit hospices in the United States. Our dedicated staff serve more than 1,400 patients and families every day in the mid-Atlantic region. Our commitment to providing the best medical care for patients with life-limiting illnesses is imperative, and we are fortunate to have skilled medical professionals, caregivers and volunteers in a four-state region.

I would like to emphasize an increasingly-utilized program for honoring patients’ wishes that is underway in Virginia. The Virginia POST (Physician Orders for Scope of Treatment) is part of the POLST (Physician Orders for Life-Sustaining Treatment) Paradigm that originated in Oregon in the 1990s to combat the "failure of advance directives." It is an approach to end-of-life planning that emphasizes advance care planning conversations and shared decision-making which culminates in the POST order set — an actionable set of medical orders that, according to the Journal of the American Geriatrics Society, is far better than advance directives in following patient’s wishes.

The Virginia POST Collaborative’s Executive Committee – consisting of members from hospital systems and other healthcare organizations throughout the Commonwealth – has designated Capital Caring as the organizational home of the program. We are deeply honored by this responsibility and excited about the opportunities and challenges that lie ahead.

Our greatest challenge is the lack of awareness and funding available for this meaningful program. Since the inception of the Virginia POST Collaborative in 2008, the program has existed only because of the in-kind donation of time and personnel by our member organizations. However, full implementation of this important initiative throughout the Commonwealth requires financial assistance from partners so that we can offer comprehensive education, provide expert training, and achieve national certification for our POST program.

Frankly, Virginia got off to a late start with the POST program and is lagging behind other states nationally and regionally. We have made great progress in the past few years, but this month should be a reminder of its importance and need.

Capital Caring has assumed the major costs of education, training, and building awareness for the Virginia POST program. Matthew G. Kestenbaum, M.D., medical director, Health Information & Training at Capital Caring, and associate medical director of the Virginia POST Collaborative (703-957-1768 or is our point person. For more details, one can contact Dr. Kestenbaum or visit our website at

The estimated annual cost for the POST program is $200,000. Any contributions are tax-deductible, and will directly impact the most frail and vulnerable citizens of the Commonwealth. We need your support, but we also need your dollars to help grow and to sustain this valuable program. Thank you for your consideration.

Malene Davis, MBA, MSN, RN, CHPN, president and chief executive officer of Capital Caring based in Falls Church and the home of the Virginia POST program, can be reached at