What is a POLST Form? (Physicians Orders for Life Sustaining Treatment)
Note: The information in this article is from the website for the National POLST program at www.polst.org. We encourage you to visit the website for additional information.
The POLST Paradigm is a process designed to improve patient care by creating a system using a portable medical order form (aka “POLST form”) that records patients’ treatment wishes. It can be used across settings of care.
A POLST form is intended to be used by individuals with a serious illness or frailty toward the end of life. For these patients, their current health status indicates the need for standing medical orders for emergency medical care. For example, one may be written for an individual with a diagnosis like cancer or needing kidney dialysis.
In a POLST conversation, the patient and his/her health care professional discuss the patient’s goals for care consistent with their values and beliefs, and the patient’s diagnosis, prognosis, and treatment options, including the benefits and burdens of those treatment options. Together they reach an informed shared decision about what treatments the patient wants in case of medical emergency.
The POLST Paradigm is not a federal mandate or program but is developed state by state. The POLST Paradigm fundamentals are the same but there may be differences among the states. The National POLST Paradigm creates quality standards for states to follow, helping to ensure patients can have their POLST form honored throughout the United States.
The POLST Paradigm is not for everyone; the POLST Paradigm is intended for patients with serious illnesses or frailty for whom their health care professionals would not be surprised if they died within a year. For these patients, their current health status indicates the need for standing medical orders for emergent medical care.
What is the Difference Between a POLST Form and an Advance Health Care Directive?
An advance directive is a legal document you use to provide guidance about what types of treatments you may want to receive in case of a future, unknown medical emergency. It also is where you say who can speak for you to make medical treatment decisions when you cannot speak for yourself (called a "surrogate"). All adults should have an advance directive.
A POLST form is a medical order for the specific medical treatments you want during a medical emergency. Not all should have a POLST form. POLST forms are appropriate for individuals with a serious illness or advanced frailty near the end-of-life.
Clinical experience and research demonstrate that advance directives are not sufficient alone to assure that those who suffer from serious illnesses or frailty will have their preferences for treatment honored unless a POLST form is also completed.
POLST forms and advance directives work together! All adults should have an advance directive, but consider POLST if and when you are diagnosed with a serious illness or frailty:
What is the Difference Between POLST and a Do Not Resuscitate Order (DDNR)?
POLST provides additional information that helps emergency personnel determine what treatments they should provide to a patient. Rather than automatically going to the hospital, a POLST may help keep the patient comfortable where they are located, if that is the treatment level they have chosen.
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 intensive care unit (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.
This additional section about desired medical treatments that a POLST form provides is incredibly important. Research has shown that when someone completes a DNR, health care professionals assume the patient wants less treatment. However, research looking at POLST forms in Oregon shows that that is not the case. Rather, approximately half of patients who complete a POLST form in Oregon indicating that they do not want CPR also show that they want full treatment or limited interventions (or a higher treatment level).
Communicating Medical Orders to Emergency Personnel Outside Facilities
The POLST form is designed to support patients transitioning between facilities- or who live outside a facility - by communicating patient treatment wishes. In the event of a medical emergency, when time is of the essence for medical decision-making, the POLST Form serves as an immediately available and recognizable order set in a standardized format to aid emergency personnel. Following the POLST form orders, emergency personnel can honor the patient’s treatment wishes as communicated to -- and documented by -- the patient’s health care professional. A POLST form assures patients that health care professionals will provide only the treatments that patients themselves wish to receive, and not the treatments they wish to avoid.
Creating a POLST Form
A POLST form is completed by a health care professional in conversation with the patient. Since it is a medical order it must be signed by a health care professional to be valid (which healthcare professional can sign varies by state). The form cannot be created by the patient themselves.
In Virginia the form must be signed by:
- A physician, nurse practitioner or physician’s assistant who has a bona fide relationship to the patient, AND
- The patient or, if the patient lacks capacity, the patient’s named health care agent, court appointed guardian, or other person legally authorized (in this order: spouse, adult children, parents, adult siblings, other relative.)
In Virginia, the form must be dated. A photocopy of the signed, dated form, is valid.
A key component of the POLST system is thoughtful, facilitated advance care planning conversations between health care professionals and patients and those close to them to determine what treatments patients do and do not want based on their personal beliefs and current state of health. In these conversations patients are informed of their treatment options and, if they wish, their health care professional completes a POLST form based on the patient’s expressed treatment preferences.
The POLST Paradigm requires health care professionals be trained to conduct shared decision-making discussions with patients and families so that POLST forms are completed properly.
Virginia POST, Kansas TPOPP, and Other State POLST Programs
POLST programs vary by state, and so do their names. For example:
- The Virginia POLST program is called POST (Physician Orders for Life Scope of Treatment) Details are here: https://www.virginiapost.org/
- The Kansas POLST program is called TPOPP (Transportable Physician Orders for Patient Preferences) Details are here: https://www.practicalbioethics.org/programs/transportable-physician-orders-for-patient-preferences
- Information about other state POLST programs in other states is available at this link.
Care is There can Help by:
- Arranging for a conversation about POLST with your doctor
If your loved one is frail or ill, we can help you coordinate their care.
Contact Care is There today for a free consultation!