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Understanding POLST (Physician Orders for Life-Sustaining Treatment): A Beginner’s Guide

Unlike an advance directive, guides for physical disposition, and instructions for managing your digital assets, Physician Orders for Life-Sustaining Treatment (POLST) do not belong in your Life File.

Moreover, not everyone should have a POLST form in the first place. However, it is vitally important you understand POLST in the event you or a loved one need to complete such a form in the future.

What is POLST?

POLST is an end-of-life planning tool, initiated when your doctor expects you to live a year or less.

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)
So I don’t need a POLST if I’m in good health currently?

Correct. A POLST is intended to be used only if you are seriously ill and at risk of experiencing a life-threatening event. An advance directive, by contrast, can and should be completed any time, independent of your current state of health. Nevertheless, it is beneficial to learn the ins and outs of POLST should you become gravely ill.

What’s included in a POLST form?

A POLST form contains your instructions for medical treatments for specific health-related emergencies or conditions: whether and/or in what context you would like to receive CPR (including intubation and defibrillation); be admitted to a hospital; receive medically-assisted nutrition; and other types of critical care.

The instructions are based on decisions made by you and your healthcare team about treatment options and goals of care.

In consultation with your doctor, you may also choose to add more personalized orders about the care you wish to receive that take into consideration the unique circumstances of your illness.

Download the National POLST form ›

How is a POLST different from an advance directive?

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.

Check out this handy chart from National POLST comparing POLST and advance directives.

How is a POLST different from a DNR?

National POLST explains the difference thusly:

Like a DNR, a POLST form lets EMS know whether or not the patient wants CPR. DNR orders only apply when a person does not have a pulse, is not breathing and is unresponsive. However, in most medical emergencies, a person does have a pulse, is breathing or is responsive. That’s where POLST is different.

A POLST form provides more information to emergency personnel than a DNR by indicating that:

  • The patient still wants full treatment, meaning that they want to go to the hospital and that all treatment options should be considered, including use of a breathing machine.
  • The patient wants limited interventions, meaning that they want basic medical treatments but wish to avoid the ICU; or
  • The patient just wants comfort measures, meaning that they do not wish to go to the hospital but want to be made comfortable wherever they are living.

Here’s a helpful sample form that breaks down each part of the form and what it means for your care.

Can I complete a POLST form on my own?

No. POLST forms must be completed and signed by a physician based on conversations they have with you about your priorities, 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.

I am not terminally ill, but I have underlying conditions that put me at high risk of complications were I to contract COVID-19. Should I consider creating a POLST form just in case?

Talk to your doctor about whether creating a POLST form is appropriate in your circumstances. Respecting Choices has an excellent document on proactive care planning for COVID-19.

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