If you've been diagnosed with a terminal illness, you may have been asked to participate in a discussion with a healthcare team which resulted in a POLST form (or a similar document like POST, MOLST or MOST). POLST stands for Physician Orders for Life-Sustaining Treatment, and is placed in a patient's medical chart.

Many healthcare systems have adopted POLST programs, and there are multiple reasons supporting the adoption of them:

1. To facilitate communication between the terminally ill patient and the healthcare team about the patient's end-of-life care wishes,
2. To convert the wishes into medical orders, and
3. To use a uniform form which can be transferred from one healthcare setting to another—including the patient's home if he or she is being cared for at home.

POLST programs are an innovative approach to ascertaining and communicating healthcare wishes, but aren't meant to replace traditional end-of-life care communication tools like Advance Directives or "no code" or "do not resuscitate" statuses. Instead, they're meant to augment and support other communication tools. They differ from Advance Directives in that Advance Directives identify a surrogate decision-maker and provide guidelines and values underlying a patient's wishes. POLST forms turn those wishes into medical actions ordered by a physician. The two are complementary in every sense.

The POLST form is signed by the physician (or other treatment provider in some healthcare systems) and represents instructions for medical treatment actions specific to different health-related emergencies or conditions. The instructions are derived from conversations between the healthcare team and the patient concerning the patient's treatment goals. POLST orders aren't limited to those restricting or eliminating treatment, but spell out treatment levels desired by the patient.

The concepts leading to POLST programs were initiated in Oregon in 1991, where POLST forms are now accepted medical standard of care. Other states have replicated Oregon's model and many others are currently considering establishing their own programs. As other states and hospitals adopted the model, they've supplemented the original work in Oregon.

Medical researchers have explored the efficacy of POLST forms, as compared to other traditional communication tools. In a 2010 article published in the Journal of the American Geriatrics Society, researchers found that among nursing home residents, those with POLST forms were more likely to have their treatment desires documented as medical orders than those without POLST forms. Additionally, the existence of a POLST order curtailing treatment was associated with a decreased use of life-sustaining measures. These findings strongly support the use of a POLST program to document and implement patient wishes at end of life.

In 2004, a national POLST task force was formed to develop and recommend best practices around the country. The task force endorses programs throughout the US (in 14 different states as of today's date) and helps others to develop (in 26 states).

POLST guidelines don't have to be instituted at the state level through legislation; a hospital or medical group can adopt them as a medical standard of care. Check out the national POLST task force website for more information about your state or community.