Planning for end-of-life care involves making personal decisions about medical treatments desired if one is unable to communicate. Clear communication of these preferences is paramount to ensure wishes are honored by healthcare providers during a medical crisis. The POLST form, known as Physician Orders for Life-Sustaining Treatment, translates patient preferences into immediate, actionable medical instructions. This document serves a distinct function in the continuum of advanced care planning.
Defining the POLST Form and Its Purpose
POLST stands for Physician Orders for Life-Sustaining Treatment, although the name can vary by state and may be called MOLST or POST. The form represents a set of standardized, portable medical orders documenting a patient’s choices regarding specific treatments. Unlike a general statement of wishes, the POLST is a true medical order signed by a qualified healthcare professional, such as a physician, nurse practitioner, or physician assistant.
The POLST program is designed for individuals who are seriously ill, medically frail, or facing a life-limiting condition. It is generally intended for those for whom death within the year would not be surprising to a clinician. This focus ensures the medical orders are based on the patient’s current health status and prognosis, not hypothetical future scenarios. The form is completed after a detailed discussion between the patient (or their surrogate) and the healthcare provider to clarify the patient’s goals of care.
POLST vs. Advance Directives: Key Differences
The POLST form is often confused with an Advance Directive, which includes legal documents like a Living Will or Durable Power of Attorney for Healthcare. A fundamental difference is the legal status: an Advance Directive is a legal instruction guiding long-term decisions and appointing a healthcare agent, but it is not a medical order. Conversely, the POLST is an actual medical order that must be followed immediately by all healthcare personnel, including emergency medical services (EMS).
Advance Directives are recommended for all adults to provide general guidance for future care. The POLST, however, is reserved for individuals with a serious, life-limiting illness whose current medical condition warrants standing orders for immediate intervention. The Advance Directive often requires interpretation to formulate a treatment plan. In contrast, the POLST provides clear, specific instructions for immediate action in an emergency. The POLST complements the Advance Directive by translating broader wishes into specific, actionable medical commands.
Key Components of the POLST Form
A typical POLST form is divided into distinct sections addressing specific life-sustaining treatments, allowing for precise, predefined choices. The first section focuses on Cardiopulmonary Resuscitation (CPR). It requires a choice between “Attempt Resuscitation/CPR” or a “Do Not Attempt Resuscitation/DNR” order. If a patient selects CPR, this choice usually necessitates selecting “Full Treatment” in the subsequent section, as resuscitation is the most aggressive intervention.
The next section details the desired Level of Medical Interventions if the patient has a pulse and is breathing but cannot communicate. Options typically include:
- Full Treatment: Involves all medically appropriate interventions, including transfer to a hospital and intensive care unit (ICU).
- Limited Treatment: Allows for basic medical care, such as antibiotics and IV fluids, but often excludes ICU admission or mechanical ventilation.
- Comfort Measures Only: Prioritizes symptom management and pain relief, with transfer to a hospital only if comfort cannot be achieved in the current setting.
Another component addresses Artificially Administered Fluids and Nutrition, detailing preferences for long-term feeding tubes or intravenous (IV) fluids. Finally, the form requires signatures from the patient or their authorized decision-maker and the healthcare provider to validate the orders. The provider’s signature confirms the orders are consistent with the patient’s preferences and current medical condition.
Implementation and Validity
Once completed, the POLST form is designed to be highly visible and portable across various care settings. It is typically printed on brightly colored paper, often pink, making it immediately recognizable to EMS personnel and other providers. This physical document is intended to travel with the patient, whether they are at home, in a nursing facility, or transferring to a hospital.
The form is a standing order, meaning it remains valid unless reviewed, modified, or revoked. Patients and surrogates can change or cancel the POLST at any time by completing a new form or voiding the existing one. Review is routinely recommended when the patient is transferred between care settings, experiences a substantial change in health status, or changes treatment preferences. POLST programs are implemented at the state level, and while efforts exist for reciprocity, a form’s validity or exact requirements may not be universally honored across state lines.