POLST, or Physician Orders for Life-Sustaining Treatment, is an approach to end-of-life care that encourages discussions between patients and their health care providers. The goal of POLST is to enable patients to choose the treatment they want or do not want, and to ensure that those preferences are honored.
With POLST, patients discuss with their doctors their diagnosis, prognosis, and treatment alternatives, including the benefits and burdens of life-sustaining treatment, as well as the patients’ values, beliefs, and goals for care. Based on these conversations, patients (or their health care agents) and their health care providers complete a POLST form, which documents the patient’s wishes with respect to end-of-life care. The POLST form is signed by the patient’s health care provider and becomes a part of the patient’s medical record. The form serves as the patient’s standing medical orders for that patient’s particular treatment preferences in the event of a medical emergency.
On a POLST form, the patient selects (1) whether or not they wish to be given CPR; (2) what degree of medical intervention they want in an acute situation: “comfort measures only,” “limited additional interventions,” or “full treatment;” and (3) the extent to which they want artificial nutrition to be administered, if at all. The POLST form is a single page, brightly colored, and designed to be immediately recognizable and used by doctors and first responders alike.
The POLST form is signed by the patient’s doctor (or, in some states, nurse practitioner or physician’s assistant) and is a medical order. A copy is kept in the patient’s medical record, so it can be easily accessed in an emergency. Some states allow the forms to be logged into an electronic registry.
The POLST Paradigm, the national organization behind POLST, advises that POLST forms are not for everyone. They are recommended for “seriously ill or frail patients for whom their physicians would not be surprised if they died in the next year.”
The POLST form does not replace an advance directive or a durable power of attorney for healthcare. The advance directive or durable power of attorney for healthcare appoints an agent or attorney-in-fact who is authorized to make medical decisions. The POLST form supplements these other documents. While the advance directive or durable power of attorney for healthcare provides instructions for future treatment, the POLST form provides medical orders for current treatment.
The POLST form is standardized by state (and the name varies by state, i.e., MOLST, MOST, COLST, etc.). Currently, POLST programs have been adopted or are in development in 43 states.
A recent study of the POLST program in Oregon indicates that the forms are making a difference in ensuring that patients’ wishes are carried out. The study looked at 58,000 people who died of natural causes in Oregon in 2010 and 2011. Researchers found that about a third of patients without a POLST form died in a hospital. Of the 18,000 patients with a POLST form, 6.4% of those who specified “comfort measures only” died in a hospital; 22.4% of those who specified “limited additional interventions” died in a hospital, and 44.2% of those who specified “full treatment” died in a hospital.
For more on POLST and the programs underway in different states, see polst.org, and speak to your physician.