A POLST form — which stands for Physician Orders for Life-Sustaining Treatment — is a medical order form that documents a seriously ill or frail person’s wishes regarding life-sustaining treatment. Unlike an advance directive which is a legal document created by the patient in advance a POLST form is a set of actual medical orders signed by a physician that can be immediately acted upon by healthcare providers in any setting.
POLST forms are known by different names in different states including MOLST — Medical Orders for Life-Sustaining Treatment — MOST — Medical Orders for Scope of Treatment — POLST Paradigm, and others. Despite the different names they serve the same essential purpose.
What a POLST form covers
A POLST form typically addresses several key medical decisions including:
- Cardiopulmonary resuscitation — CPR — whether the person wants CPR attempted if their heart stops or they stop breathing
- Medical interventions — the level of medical treatment desired ranging from comfort focused care only to full treatment including hospitalization and intensive care
- Artificial nutrition — whether the person wants a feeding tube if they are unable to eat or swallow on their own
Some POLST forms also address other decisions such as the use of antibiotics, hospitalization preferences, and dialysis.
How a POLST form differs from an advance directive
A POLST form and an advance directive — such as a living will or healthcare power of attorney — are related but serve different purposes and work in different ways:
- Who creates it — an advance directive is created by the patient and documents their general wishes. A POLST form is a medical order created by a physician in conversation with the patient or their representative based on the patient’s current medical condition and wishes.
- When it is used — an advance directive is created in advance for use in future situations. A POLST form is typically created when a person has a serious illness or frailty and addresses their current medical situation.
- Legal status — an advance directive is a legal document. A POLST form is a medical order that has immediate authority in healthcare settings.
- Who it applies to — advance directives are appropriate for all adults. POLST forms are specifically designed for people with serious illness, advanced frailty, or a limited life expectancy — generally those for whom a physician would not be surprised if they died within one to two years.
- Portability — a POLST form is designed to travel with the patient across all care settings — from home to emergency services to hospital to nursing home — providing consistent guidance wherever the person receives care.
Who should have a POLST form
A POLST form is not appropriate for all adults — it is specifically designed for people who:
- Have a serious illness such as advanced cancer, end stage heart disease, or advanced dementia
- Are elderly and frail with a limited life expectancy
- Are receiving hospice care
- Have clear wishes about life-sustaining treatment that they want immediately honored in any healthcare setting
- Are at risk of a medical emergency in which first responders or emergency room staff would need immediate guidance about their treatment wishes
For healthy adults who want to document their general wishes about future medical care an advance directive is the more appropriate document. A POLST form becomes relevant when a person’s health has declined to a point where end of life decisions are an immediate and practical concern.
How a POLST form is created
A POLST form is created through a conversation between the patient — or their authorized decision maker if the patient lacks capacity — and their physician or other qualified healthcare provider. The conversation should cover:
- The patient’s current medical condition and prognosis
- The patient’s values, goals, and wishes regarding medical treatment
- The potential benefits and burdens of different treatment options
- What the patient would and would not want in specific medical scenarios
After this conversation the physician completes the POLST form documenting the agreed-upon orders and signs it. The patient or their representative also typically signs the form. The completed form is then placed in the patient’s medical record and a copy is kept wherever the patient lives or receives care.
Where to keep a POLST form
Because a POLST form is a medical order it must be immediately accessible to healthcare providers in any setting where the person receives care. Recommended locations include:
- On the refrigerator door at home — emergency medical personnel are trained to look there
- With the patient’s other medical records at home
- In the patient’s medical chart at their physician’s office
- In the patient’s chart at any nursing home or care facility where they reside
- With the patient when they travel or are away from home
Some states maintain POLST registries where completed forms can be stored electronically and accessed by healthcare providers statewide.
POLST forms and emergency medical services
One of the most important features of a POLST form is that it provides guidance to emergency medical services — EMS — personnel who respond to a 911 call. Without a POLST form or similar out-of-hospital medical order EMS personnel are generally required to attempt full resuscitation when called to the scene of a medical emergency regardless of the patient’s wishes.
A properly completed POLST form gives EMS personnel legal authority to honor the patient’s wishes — including a decision not to attempt CPR — when responding to an emergency at the patient’s home or other non-hospital setting.
Can a POLST form be changed
Yes — a POLST form can be updated or revoked at any time by the patient if they have decision-making capacity. If the patient’s medical condition or wishes change a new POLST form should be completed with updated orders. Old POLST forms should be destroyed when a new one is created to avoid confusion.
POLST forms and hospice care
POLST forms are commonly used in conjunction with hospice care. People receiving hospice care have typically chosen to focus on comfort rather than life-prolonging treatment and a POLST form documenting this choice ensures that their wishes are honored by all healthcare providers involved in their care including emergency responders.
Finding POLST resources in your state
POLST forms are state-specific and must comply with your state’s laws and regulations. The National POLST organization at polst.org provides information about POLST programs in each state including state-specific forms and educational resources.
Your physician, hospital social worker, or local hospice organization can also provide information about the POLST form used in your state and help you complete one if appropriate.
Key terms to know
- POLST — Physician Orders for Life-Sustaining Treatment, a medical order form documenting wishes regarding life-sustaining treatment
- MOLST — Medical Orders for Life-Sustaining Treatment, another name for POLST used in some states
- Advance directive — a legal document describing medical treatment wishes and naming a healthcare decision maker
- CPR — cardiopulmonary resuscitation, an emergency procedure used to restore heart and breathing function
- Life-sustaining treatment — medical interventions that may prolong life including CPR mechanical ventilation and artificial nutrition
- Out-of-hospital medical order — a medical order that applies outside of a hospital setting such as at home or in a nursing facility
- Hospice care — care focused on comfort and quality of life for people with a terminal illness
Sources
- National POLST — polst.org
- National Institute on Aging — Advance Care Planning
- Centers for Medicare and Medicaid Services
- American Bar Association — Public Resources
This article is for general informational purposes only and does not constitute legal or medical advice. POLST forms vary by state. Consult a physician or licensed healthcare provider for guidance specific to your situation.