POLST and How They Work with Advance Directives

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Image care of the POLST website
Image care of the POLST website

This blog post is the fourth in a series of guest posts by Arashi about end-of-life care planning and documentation in honor of National Healthcare Decisions Day.

POLST forms are another type of end of life planning tool. POLST stands for Physician Orders for Life-Sustaining Treatment. They’re also known as; medical orders on life-sustaining treatment (MOLST), medical orders on scope of treatment (MOST), or physician’s orders on scope of treatment (POST). The first POLST program was developed in Oregon in 1991 to create a standardized, easily recognizable, portable document which is designed to be transferable and actionable throughout the entire medical community.

POLST differs from advance directives in a number of ways. When one fills out an advanced directive, he or she is considering end-of-life choices regarding a myriad of future treatments. For example, if a person went into a persistent vegetative state with little to no hope of recovery would that person would want life sustaining technologies? An advance directive could be filled out at any time by any person independent of his/her current state of health. A POLST form is intended to be used by those who are seriously ill and are considering specific options regarding life support. A POLST form is started with a conversation between patient and physician. An advance directive should have a clear statement of general preferences while the POLST form is selecting from a set of choices. An advance directive generally requires some interpretation of preferences but a POLST form is intended to be an actionable order requiring no interpretation if or when the existent circumstances require it.

The POLST form was created to remedy some of the disadvantages of the advance directives. Advance directives do a good job of getting a general sense of what a person would want in 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 too ambiguous, the patient’s loved ones are still in the position of “deciding in the dark” what the patient really wanted. POLST forms also evolve with life sustaining technologies ensuring the patient is up-to-date on exactly what life support choices are being employed.

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. People can download an advance directive online and fill it out in a matter of hours. The disadvantage to this is the paperwork is with the patient when it should be shared with the 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 the patient’s chart. They’re standardized and easily recognizable and designed to be transferable throughout different medical facilities.

POLST orders and advance directives are designed to work with each other. Advance directives should be considered general documentation of end-of-life care wishes while POLST orders are specific instances of physician’s orders. Everyone should have an advance directive written out—no matter how young or old or sick or healthy—they’re a “just in case” coverage of intentions. If a person is in a position where he or she has a prognosis of a year or less to live, having a POLST form is recommended.

POLST orders should be considered a second step to advance directives. POLST forms are a way to take one’s wishes from his or her 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 find more accuracy of end-of-life preferences when the patient has a completed POLST order. And patients are more likely to receive the end-of-life treatments they desire when they have a POLST form.

View full post on Death with Dignity National Center



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