A POLST Paradigm Form is neither an advance directive nor a replacement for advance directives. However, both advance directives and POLST Paradigm Forms are helpful advance care planning documents for communicating patient wishes when appropriately used.
An advance directive is a form in which an individual: (1) appoints a person or persons to make health care decisions for the individual if and when the individual loses the capacity to make health care decision (typically called a “health care power of attorney”); and/or (2) provides guidance or instructions for making health care decisions, typically in end-of-life care situations (often called a “living will”). An advance directive is a direction from the patient, not a medical order.
In contrast, a POLST Paradigm Form consists of a set of medical orders that applies to a limited population of patients and addresses a limited number of critical medical decisions. The form is intended as a complement to advance directives in that it serves as a translational tool and a continuity of care assurance.
Both provide information about treatment wishes but they give different information:
- Advance Directive: This document is called different things in different states (e.g., living will, health care power of attorney) but, regardless of the term, is a legal document used to provide guidance about what types of treatments a patient may want to receive in case of a future, unknown medical emergency; it is also where patients designate a surrogate. All adults should have an advance directive. ......... ....... ...
- Physician Orders for Life-Sustaining Treatment (POLST) Paradigm Form: This is also called different things in different states (see our map for more information) but, regardless of the term, the POLST Paradigm Form is a portable medical order for specific medical treatments the patient would want tonight (based on his/her diagnosis, prognosis and goals of care). Only individuals with a serious illness or frailty near the end-of-life should have this form.
A POLST Paradigm Form is a medical order that tells emergency health care professionals what to do during a medical crisis where the patient cannot speak for him or herself. An advance directive is a legal document that tells who the patient wants making medical treatment decisions for him/her when he/she cannot speak and gives general directions on treatments the patient does or does not want to help create a treatment plan.
|POLST Paradigm Form||Advance Directive|
|Type of Document||Medical Order||Legal Document|
|Who Completes||Health Care Professional||Individual|
|Who Needs One||Seriously ill or frail (any age) for whom health care professional wouldn’t be surprised if died within 1 year||All competent adults|
|Appoints a Surrogate||No||Yes|
|What is Communicated||Specific medical orders for treatment wishes during a medical emergency||General wishes about treatment wishes. May help guide treatment plan after a medical emergency.|
|Can EMS Use||Yes||No|
|Ease in locating||Very easy to find. Patient has original. Copy is in medical record. Copy may be in a Registry (if your state has a Registry).||Not very easy to find. Depends on where patient keeps it and if they have told someone where it is, given a copy to surrogate or to health care professional to put in his/her medical record.|