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POLST (Physician Orders for Life-Sustaining Treatment)

Depending on the state, POLSTs are also known by varying names:

  • Medical Orders for Life-Sustaining Treatment (MOLST)
  • Medical Orders on Scope of Treatment (MOST)
  • Physician’s Orders on Scope of Treatment (POST)
  • Transportable Physician Orders for Patient Preferences (TPOPP).

POLST, or Physician Orders for Life-Sustaining Treatment, is an end-of-life planning tool, initiated when your doctor expects you to live a year or less. It contains your instructions for medical treatments for specific health-related emergencies or conditions. The instructions are based on decisions made by you and your healthcare team. placed in your medical chart. POLSTs don’t restrict or eliminate treatment. Rather they spell out treatment levels you desire. The POLST is jointly signed by you and your doctor.

The first POLST program was developed in Oregon in 1991 to create a standardized, easily recognizable, portable document that is valid throughout the entire medical community. In Oregon, POLST forms are now accepted medical standard of care. Some states have replicated Oregon’s model and many others are considering adopting them.

Efficacy of POLST

Medical researchers have explored the efficacy of POLST 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 POLSTs were more likely to have their treatment desires documented as medical orders than those without them. Additionally, the existence of a POLST curtailing treatment was associated with a decreased use of life-sustaining measures. These findings strongly support the use of a POLST program.

POLST vs. Advance Directive

POLST is an innovative approach to ascertaining and communicating healthcare wishes, but it isn’t meant to replace traditional end-of-life care communication tools like advance directives or “no code” or DNR (Do Not Resuscitate) statuses. Instead, it augments and supports other communication tools.

Whereas advance directives identify a surrogate decision-maker and provide guidelines and values underlying a patient’s wishes, POLSTs turn those wishes into medical actions ordered by a physician. The two are complementary in every sense.

Timing

When you fill out an advanced directive, you are considering a myriad of future medical interventions. You can and should fill out an advance directive at any time independent of your current state of health. In contrast a POLST is intended to be used only if you are seriously ill.

Scope

Although you can personalize your advance directive with specific instructions, generally it serves as a clear statement of general preferences. In contrast, the POLST form involves selecting from a set of choices. An advance directive generally requires some interpretation of preferences but a POLST is intended to be an actionable order requiring no interpretation if or when the circumstances require it.

The POLST was created to remedy some of the disadvantages of the advance directives which convey a general sense of what you would want in various end-of-life scenarios but often aren’t specific enough. They require a treating physician to translate intentions into orders. If the language of the advance directive is ambiguous, your loved ones are in the position of “deciding in the dark” what you really wanted.

POLSTs are amended as life sustaining technologies evolve, ensuring you are up-to-date on exactly what life support choices are being employed.

It’s in Your Chart

One advantage of advance directives is they can be done without the help of a lawyer or physician and they’re still able to be used to guide patient care. You can download an advance directive online and fill it out in a matter of hours. The disadvantage is that the paperwork is with you when it should be shared with medical professionals. POLST forms are available at doctors’ offices, completed with the help of a physician, and are created with the intent of going into your medical chart. They’re standardized, easily recognizable, and designed to be transferable throughout different medical facilities.

Advance Directive First, POLST Second

POLST orders should be considered the next step after advance directives. They are a way to take your wishes from your advance directive and set them down in an unambiguous and concrete manner which is easily understood and applicable when needed. Research has shown the use of POLST forms results in higher levels of compliance from medical professionals. From physicians to EMTs to hospice care workers, most healthcare professionals feel they are better guided in the patient’s end-of-life preferences when there is a completed POLST. And you are more likely to receive the end-of-life treatments you desire when you have a POLST form.

Note: This page combines and adapts material authored by Peg Sandeen and Arashi Young, published on the previous iteration of our website as blog posts.