Study Reviewed Variation in POLST Forms among All State Programs

Variations in POLST forms across the nation examined

“Variations in Physician Orders for Life-Sustaining Treatment Program across the Nation: Environmental Scan” was published in the Journal of Palliative Medicine.

One objective was to see if variation was related to program maturity

This study by Aluem Tark, FNP-BC, RN, CHPN, Mansi Agarwal, PhD, MPH, Andrew Dick, PhD, and Patricia W Stone, PhD, PN, FAAN, examined the variation among all state POLST forms across the U.S. and sought to determine whether variations were associated with program maturity status (as designated by the National POLST Paradigm).

Data was collected by environmental scanning

Environmental scanning is a research method in which publicly available information is systematically gathered for comparison and evaluation.

Fifty-one programs were considered (all 50 states and Washington DC)

Data were gathered by internet search, with the National POLST Paradigm website being the main source of information for the POLST programs in the 50 states and Washington DC. For simplicity, the paper referred to all of the programs as state programs, including that of Washington DC. (The National POLST Paradigm notes that Kansas and Missouri actually administer a joint program, not so noted in this study; however it has little bearing on the study.)

This study attempted to gather data on overall variation across POLST forms from all POLST programs (non-conforming, developing, endorsed, and mature), including the types of interventions included on the form, and location or frequencies of options presented on the forms.

In contrast, the study by Hickman and Critser (2018) examined only endorsed programs and had a different goal of comparing the forms’ adherence to national standards.

Variation was not found to be related to maturity status

Variations in the POLST forms were not found to be related to program maturity. Instead, the study authors felt the explanation was a lack of consensus on the end-of-life treatment options that should be addressed.

Study authors note that national standardization would be beneficial

Because the purpose of POLST is to facilitate advance care planning for those near the end of life, study authors assert that a nationally standardized tool that would be recognized and honored across all states would be best for ensuring that POLST forms are easily identified and that patient wishes are respected.


Tark A, M Agarwal, AW Dick, and PW Stone (2019). Variation in POLST across the Nation: Environmental Scan. Journal of Palliative Medicine, ePub ahead of print.

Hickman S and R Critser (2018). National Standards and State Variation in Physician Orders for Life-Sustaining Treatment Forms. Journal of Palliative Medicine, 21(7).

Research Article: National Standards and State Variation in POLST Forms.