A Clinical Order Articulating Scope of Treatment (COAST) form is an individualised plan for end of life care that considers both patient preferences and clinical judgment based on medical evaluation. It is a communication tool for health professionals with a set of default orders that can be easily utilized across all health settings and encounters. The aim of the COAST process is to efficiently communicate and coordinate goal-directed clinical care, thereby improving the end of life experience for patients and families.
COAST is based on the POLST process in the United States and the Goals of Care initiative in Australia. It has been adapted to a New Zealand population and – at this stage – is being piloted in Southland as part of a quality improvement initiative.
This form is completed by either a doctor (any grade) or nurse practitioner after thorough patient/proxy discussion regarding the patient’s treatment preferences and current health status. Just as a written prescription does not replace a comprehensive discussion about medications with the patient/proxy, the COAST form is not a substitute for advance care planning discussions.
In order to be valid, each field should be completed and the form must be signed and dated by the treating doctor or nurse practitioner (NP).
COAST Form & Process Video
Please find below all of the downloadable forms:
Forms can be electronically uploaded to Health Connect South.
PLEASE NOTE: We are not currently recruiting participants for our research study so these forms are no longer required when a COAST Form is completed.
The Research Project
The primary aim of the study will be to evaluate if the introduction of the document in southern New Zealand reduces hospitalisations for patients in their final year of life. The secondary aim of the study will be to assess the acceptability of the document from healthcare professionals involved in its use and also patients and/or their proxy.
Patients will be asked to give informed consent to allow us to access their electronic health records. Patient demographics will recorded, including age, gender, ethnicity, principal diagnosis, place and type of residence, and the encounter setting for discussion and completion of COAST.
Part 1 of data collection will involve retrospective audit to assess number of emergency department presentations and hospitalisations in the 12 months preceding study enrolment, using Health Connect South. Part 2 of data collection will involve assessing number of emergency department presentations, hospitalisations, COAST form revocations and/or revisions, and care environment transitions for 12 months after study enrolment, using Health Connect South. Place and cause of death, if applicable, will be recorded.
Participants will be asked to complete a survey about their experience of COAST, and provided with a postage-paid addressed envelope.
We ask that a copy of the COAST form and the consent form is sent to COAST@hospicesouthland.org.nz +/- faxed to 03 211 3082.
Please note we are no longer recruiting for the research study so consent forms are no longer required.
Frequently Asked Questions
Firstly, ask yourself: “Would I be surprised if this patient dies in the next year?” If the answer is “no”, then a COAST form should be completed for the individual. This includes patients receiving hospice care, those with a terminal diagnosis, and patients with advanced dementia.
At this time, the COAST form is intended only for adult patients (age 18 or older).
The treating doctor or NP should complete and sign the COAST form. In most cases, this will be the GP. However, any doctor or NP who encounters an eligible patient should complete and sign the COAST form if it has not already been done.
Individuals retain the original copy of their COAST form, whilst another copy is retained in the patient’s paper notes. We are hopeful the form will soon be available electronically in Health Connect South. The COAST form should be readily available to all treating health providers; individual agencies or facilities may need their own processes to ensure that the COAST form is accessible.
Yes. A COAST form can be changed in one of two ways:
- By completing and signing a new COAST form. The new COAST form automatically replaces any previous version(s). The valid COAST form is the one that is most recently completed, signed, and dated.
- By revoking the original COAST form and leaving it unreplaced. This can be done at the request of the patient, proxy, or treating doctor/nurse practitioner. Revocation is documented in writing by striking through the COAST document and writing “REVOKED” along with the date, a brief explanation of the revocation, and the signature and printed name of the health provider.
Yes. The orders on a COAST form may be disregarded in the following circumstances:
- If fulfilling these orders involve providing medical care which is not equivalent to current healthcare standards.
- If the authenticity of the COAST form is called into question
- If all fields are not completed and/or the form is not signed/dated by the doctor/nurse practitioner.
The COAST form does not have an expiration date. COAST form should be reviewed periodically and updated as appropriate if:
- There is a significant change in an individual’s health status
- The individual’s treatment preferences change
No, the COAST form is meant to complement Advanced Care Planning. If COAST form orders directly conflict with orders stated in a patient’s Advanced Care Plan, the most recent document takes precedence.
A facility is welcome to have its own processes and documentation methods. If this is the case, the COAST form should still be completed for all eligible patients. The COAST form is intended to be a shared tool that streamlines and co-ordinates care across all settings.
This study is being conducted by Hospice Southland in collaboration with Southern District Health Board. Study investigators also have affiliations with the University of Otago. The study has gained ethical approval from Health and Disability Ethics Committee New Zealand.
The form can still be used as it is a medical order, but we cannot collect data about the patient or presentations to hospital.
Patients unable to give informed consent can still be included in the research if the health professional deems it in their best interest, in accordance with Right 7.4 of the The Code of Health and Disability Services Consumers’ Rights. There is a tick box on the consent form to indicate this.
Post-COAST Survey for Healthcare Providers
You are invited to take part in a study looking at whether Introducing and implementing a transferable, readily accessible, and actionable end of life planning tool for patients with advanced serious illness or frailty is acceptable in southern New Zealand. Whether or not you take part is your choice. If you don’t want to take part, you don’t have to give a reason, and it won’t affect your career.
You have been selected for participation in this study because you provide care to patients with advanced and progressive illness and/or frailty, thought to be in their last year of life, and may have completed a COAST form, as part of a local pilot initiative.
Through completing the online survey, your consent for us to use this information for the purposes of this study will be assumed. However, formal written consent forms will be available if you would prefer.
If you have any questions or concerns please contact:
Hospice Southland, 75 Kew Road, Invercargill, 9810
0800 211 308
COAST@hospicesouthland.org.nz
