Patient FAQs

The POLST Paradigm is a process designed to improve patient care by creating a system using a portable medical order form (aka “POLST Form”) that records patients’ treatment wishes. It can be used across settings of care. A POLST Form is intended to be used by individuals with a serious illness or frailty toward the end of life. For these patients, their current health status indicates the need for standing medical orders for emergency medical care. For example, one may be written for an individual with a diagnosis like cancer or needing kidney dialysis.

In a POLST conversation, the patient and his/her health care professional discuss the patient’s goals for care consistent with their values and beliefs, and the patient’s diagnosis, prognosis, and treatment options, including the benefits and burdens of those treatment options. Together they reach an informed shared decision about what treatments the patient wants in case of medical emergency.

The POLST Paradigm is not a federal mandate or program but is developed state by state. The POLST Paradigm fundamentals are the same but there may be differences among the states. The National POLST Paradigm Task Force creates quality standards for states to follow, helping to ensure patients can have their POLST Form honored throughout the United States.

You can learn more about your state’s POLST Program by clicking on your state: http://www.polst.org/programs-in-your-state/

A Physician Orders for Life-Sustaining Treatment (POLST*) Form helps individuals with serious illness or frailty for whom their health care professional wouldn’t be surprised if they died within a year communicate their treatment decisions. It is designed to improve patient care by creating a portable medical order form (the POLST Form) that records patients’ treatment wishes so that emergency personnel know what treatments the patient wants in the event of a medical emergency.

The current standard of care during an emergency is for emergency medical services (EMS) to attempt everything possible to attempt to save a life. Not all patients who are seriously ill or frail want this treatment and the POLST Paradigm provides the option for them to: (1) confirm this is the treatment they want or (2) to state what level of treatment they do want.

*POLST is known by different names in different states; for simplicity, the term POLST is used when referring to POLST Forms or programs in general.  For the list of names, see http://www.polst.org/programs-in-your-state/

The POLST Form documents the medical orders that helps give patients more control over receiving treatments they do want to receive, and avoiding treatments they do not want to receive, in the event they cannot speak for themselves during a medical crisis.

All competent adults should have advance directives, documenting who they want to speak for them whenever they lack capacity to speak for themselves.  Both advance directives and POLST Forms are advance care plans.  They support each other but do different things. For more information see: http://polst.org/advance-care-planning/polst-and-advance-directives/

POLST is not for everyone. POLST is for those with serious illness or frailty—such as advanced heart disease, advanced lung disease or cancer that has spread—for whom their health care professional wouldn’t be surprised if they died within a year.

Most people are too healthy to need a POLST Form. If something suddenly happened, many healthy seniors would want everything done while more was learned about what was wrong and about their chances of recovery. Healthy people should have an advance directive. Later, if the patient became sicker or frailer, they or their surrogate (example, Power of Attorney for Health Care*) can complete a POLST Form to turn their treatment wishes into a medical order that can be followed by EMS.

* For a list of alternative titles for “Durable Power of Attorney for Health Care” refer to: http://www.nolo.com/legal-encyclopedia/health-care-declarations-your-state.html

A POLST Form is completed by a health care professional in conversation with the patient. Since it is a medical order it must be signed by a health care professional to be valid (which health care professional can sign varies by state). Most states also require the patient or their surrogate sign the form. (In states where the patient’s signature is not required, we encourage the patient to sign indicating their agreement to the orders.)

Patients should not be provided a POLST Form to complete on their own.  A POLST Form should never be completed without a conversation with the patient, or his/her surrogate, about diagnosis, prognosis, treatment options and goals of care.

No. Completing a POLST Form should always be voluntary. If someone is being forced to complete a form, contact us at admin@polst.org, or his/her state contact at http://www.polst.org/programs-inyour-state/

Yes! POLST Forms were created to be easily modified and updated. As your medical condition changes or your goals of care change, you can update your POLST Form anytime by talking with your health care professional.

Additionally, health care professionals are encouraged to review your POLST Form with you periodically—especially when you are transferred from one care setting or care level to another (e.g., upon admission and discharge from every facility) or when there is a substantial change in your health status.

If you ever decide that a POLST Form is no longer appropriate for you, it is also easily voided. It is preferred that you consult your health care professional to void your form. On the backside, the POLST Form has information about how it can be voided (usually by drawing a line across the form and writing “VOID” in large letters). You must notify your health care professional to make sure your medical record is updated. If you live in a state with a Registry, you must also notify the Registry that your form is no longer valid.

The surrogate your loved one has appointed in his/her advance directive can help the healthcare professional complete a POLST Form based on your loved one’s surrogate’s understanding of his/her wishes. The surrogate then signs the POLST Form on behalf of your loved one. 

POLST Form medical orders give you more control over receiving treatments you want to receive and avoiding treatments you do not want to receive in the event you are unable to speak for yourself during a medical emergency.  If you want everything possible done during a medical emergency then your health care professional would complete the form showing “CPR” and “Full Treatment.” Conversely, if you want other treatment, your health care professional would complete the form showing “Comfort Measures Only” or “Limited Treatment”.

Additionally, endorsed POLST Forms* state that ordinary measures to improve the patient’s comfort, and food and fluid by mouth as tolerated, are always provided.

* To find states that have endorsed POLST Forms, refer to http://www.polst.org/programs-in-your-state/

Yes. Endorsed POLST Forms state that ordinary measures to improve the patient’s comfort, and food and fluid by mouth as tolerated, are always provided. However, POLST Forms allow you to choose whether you would like artificially administered nutrition (and sometimes hydration).

During a conversation with a health care professional, you determine what you want and do not want in a medical emergency, and then that section will be completed in accordance with your wishes.

No. Both advance directives and POLST Forms are advance care plans.  They support each other but do different things. For more information see: http://polst.org/advance-care-planning/polst-and-advance-directives/

2017.03.27 POLST vs. Advance Directives

While the advance directive varies in name and information by state, generally an advance directive allows a patient to:

• Identify the person he/she wants the health care team to work with in making decisions about his/her medical care (known as a “surrogate”). A POLST Form cannot be used to identify a surrogate.
• Generally says what kinds of medical treatment he/she would or would not want and is not specific to a particular medical condition (such as advanced heart disease, advanced lung disease or cancer). An advance directive is a legal document that should be completed by all adults.

The POLST Form gives medical orders to emergency personnel for what treatments to provide to the patient when the patient is having a medical emergency but cannot speak or communicate.

A better question might be “Does POLST identify DNR preferences?” Yes—but it does more! A POLST provides additional information that helps emergency personnel determine what treatments they should provide to a patient. Rather than automatically going to the hospital, a POLST may help keep the patient comfortable where they are located, if that is the treatment level they have chosen.

Like a DNR, a POLST Form lets EMS know whether or not the patient wants CPR. DNR orders only apply when a person does not have a pulse, is not breathing and is unresponsive. However, in most medical emergencies, a person does have a pulse, is breathing or is responsive. That’s where POLST is different.

A POLST Form provides more information to emergency personnel than a DNR by indicating that:

1. The patient still wants full treatment, meaning that they want to go to the hospital and that all treatment options should be considered, including use of a breathing machine;
2. The patient wants limited interventions, meaning that they want basic medical treatments but wish to avoid the intensive care unit (ICU); or
3. The patient just wants comfort measures, meaning that they do not wish to go to the hospital but want to be made comfortable wherever they are living.

This additional section about desired medical treatments that a POLST Form provides is incredibly important. Research has shown that when someone completes a DNR, health care professionals assume the patient wants less treatment. However, research looking at POLST Forms in Oregon shows that that is not the case. Rather, approximately half of patients who complete a POLST Form in Oregon indicating that they do not want CPR also show that they want full treatment or limited interventions (or a higher treatment level).

No. The National POLST Paradigm recognizes that allowing natural death to occur is not the same as killing. A POLST Form does not allow for active euthanasia or physician assisted suicide. 

A POLST Form is specifically about how people want to live. If a POLST Form is used inappropriately it is a medical error and the health care professional should be reported in accordance with facility policies and/or to an appropriate licensing or professional board.

It depends on many factors. If you are traveling to another state, it is a good idea to take your Advance Directive and your POLST Form with you. Both documents, even if not legally binding, will help healthcare professionals know your wishes and a new POLST Form can be completed.

If you are moving, you should bring your POLST Form with you to your first appointment with your new health care professional to put your wishes on that state’s POLST Paradigm Form. You should also talk to your attorney about updating your advance directive as some states require you use a specific form in order for your advance directive to be valid.

Talk to your health care professional.  Since a POLST Form is a medical order it must be signed by a health care professional to be valid. 

Patients should not be provided a POLST Form to complete on their own.  A POLST Form should never be completed without a conversation with the patient, or his/her surrogate, about diagnosis, prognosis, treatment options and goals of care.

A POLST Form always remains with the patient, regardless of whether the patient is in the hospital, at home or in a nursing home. The form should be placed in a visible location recognized by emergency medical personnel (usually the front of the refrigerator or in a medicine cabinet). In a health care facility a copy of the POLST Form should be in the medical record.