Physician Orders for Life-Sustaining Treatment

POLST (Physician Orders for Life-Sustaining Treatment) is an approach to improving end-of-life care in the United States, encouraging providers to speak with the severely ill and create specific medical orders to be honored by health care workers during a medical crisis.[1] POLST began in Oregon in 1991 and currently exists in 46 states, British Columbia, and South Korea.[2] The POLST document is a standardized, portable, brightly colored single page medical order that documents a conversation between a provider and an individual with a serious illness or frailty towards the end of life. A POLST form allows emergency medical services to provide treatment that the individual prefers before possibly transporting to an emergency facility.

The POLST form is a medical order which means that the POLST form is always signed by a medical professional and, depending upon the state, the person stated on the form can sign as well. A pragmatic rule for initiating a POLST can be if the clinician would not be surprised if the individual were to die within one year.[3] One difference between a POLST form and an advance directive is that the POLST form is designed to be actionable throughout an entire community.[4] It is immediately recognizable and can be used by doctors and first responders (including paramedics, fire departments, police, emergency rooms, hospitals and nursing homes). Comparing to documents like DNI (Do Not Intubate), DNR (Do Not Resuscitate) and advance directive, the POLST form provides more information on the types of end-of-life treatment or intervention that the severely ill wishes to receive.[5]

Organizations that have passed formal resolutions in support of POLST include the American Bar Association[6] and the Society for Post-Acute and Long-Term Care Medicine[7] (AMDA). Other organizations that support POLST include the American Nurses Association[8] (ANA); the Institute of Medicine;[9] National Association of Social Workers[10] (NASW); AARP;[11] the American Academy of Hospice and Palliative Medicine[12] (AAHPM); Pew Charitable Trusts;[13] and the Catholic Health Association of the United States [14](CHA).

POLST orders are also known by other names in some states: Medical Orders for Life-Sustaining Treatment (MOLST), Medical Orders on Scope of Treatment (MOST), Physician's Orders on Scope of Treatment (POST) or Transportable Physician Orders for Patient Preferences (TPOPP).[15]

  1. ^ Meier DE, Beresford L (April 2009). "POLST offers next stage in honoring patient preferences". Journal of Palliative Medicine. 12 (4): 291–5. doi:10.1089/jpm.2009.9648. PMID 19327064.
  2. ^ Scotti S (March 2016). "Physician Orders for Life-Sustaining Treatment". NCSL Legisbrief. 24 (11): 1–2. PMID 27032129.
  3. ^ Sabatino C, Naomi K. Improving Advanced Illness Care: The Evolution of State POLST Programs (Report). AARP Public Policy Institute.
  4. ^ Cite error: The named reference :3 was invoked but never defined (see the help page).
  5. ^ Cite error: The named reference :4 was invoked but never defined (see the help page).
  6. ^ "American Bar Assoc resolution" (PDF). August 12, 2008.
  7. ^ "The Society For Post Acute And Long Term Care Medicine". March 1, 2014.
  8. ^ "American Nurses Association" (PDF). June 14, 2010. Archived from the original (PDF) on November 23, 2015.
  9. ^ "Institute of Medicine, "Dying in America" report - Key Findings (pg 5)". 17 September 2014.
  10. ^ "NASW Recommendations for the 2015 White House Conference on Aging" (PDF). June 15, 2015. Archived from the original (PDF) on September 6, 2015.
  11. ^ "AARP, "Improving Advanced Illness Care: The Evolution of State POLST Programs"" (PDF). April 2011.
  12. ^ "AAHPM: Advance Care Planning". Retrieved April 7, 2016.
  13. ^ "Pew Trusts: Capturing Treatment Preferences for End-of-Life Care". December 10, 2015.
  14. ^ "Catholic Health Association, Ethical Currents: POLST" (PDF). 2010. Retrieved April 7, 2016.
  15. ^ Frieden J (2008). "Hospitals, LTC Facilities Are Moving Toward Newer End-of-Life Strategies: Physician Orders for Life-Sustaining Treatment orders are joined by default surrogate approach" (PDF). Caring for Aging. 9 (11): 5. doi:10.1016/s1526-4114(08)60296-6.[dead link]