The success of the National POLST Paradigm requires all state programs share the same vision and adoption and implementation of consistent messages, processes, and forms to support seriously ill or frail individuals wanting to participate in the POLST Paradigm. Our vision is the “adoption of the POLST Paradigm by all states, resulting in consistency of process, improved patient care and greater patient control and direction over medical treatments they receive.” Success means a seriously ill or frail person with a POLST form can travel anywhere in the United States and, if they have a medical emergency, have that POLST form found and honored.
In 2004, the National POLST Paradigm Task Force formed, in part, to develop that consistency by establishing program and form standards (now our endorsement requirements), giving states interested in implementing their own POLST Paradigm program a structured approach to follow. Almost all state POLST programs have chosen to participate in the national movement and follow these standards.
Susan Hickman and Rebecca Crister’s article emphasizes the need for consistency and gives a gauge about our success to date. There are several things to note:
- This article represents a single moment. Since their review of POLST forms for this article was completed, several states have updated their forms, making them more consistent with national standards.
- This article provides examples of when endorsement requirements are unclear and emphasizes the need for clarity specifically regarding POLST form standards (requirements and suggestions). The National POLST Paradigm agrees and started the process of reviewing and updating the mature and endorsed applications in August 2017 (expected completion of mature standards is in 2018, endorsement standards in 2019).
The National POLST Paradigm recognized there is a need to develop and encourage all states to use a single national form. We are grateful the Gordon & Betty Moore Foundation provided a grant to create a single national POLST form that states can choose to use going forward (expected April 2019). A second deliverable for this grant is guidance that will provide objective rationale for required, recommended, and not recommended form elements that states whose laws or regulations do not support the national form can use to update their forms to be as similar as possible to the national form.
The process for developing the form and guidance includes all state programs in the review process, multiple times. There is a coalition or task force in all 50 states and Washington DC; leaders from each of these programs:
- have been invited to participate in a 1:1 interview about their form (and, if applicable, its iterations);
- will be able to provide additional feedback on form issues during a survey expected this fall; and
- will be able to provide comment on the proposed form and accompanying guidance late 2018/early 2019.
The final form and guidance will be approved by the Plenary Assembly in 2019.