The National POLST Paradigm is an approach to end-of-life planning that emphasizes eliciting, documenting and honoring patients’ treatment preferences using a portable medical order (a POLST form). The POLST Paradigm emphasizes: (i) advance care planning conversations between patients, health care professionals and loved ones; (ii) informed shared decision-making between a patient and his/her health care professional about the treatment the patient would like to receive at the end of his/her life; and (iii) ensuring patient treatment wishes are honored. The POLST form is the most visible part of the POLST Paradigm--helping to ensure patient treatment wishes are communicated to health care professionals when the patient cannot speak for him/herself--but the most important part of the Paradigm is the conversation and process for completing the form.
A POLST form is not for everyone. The POLST decision-making process and resulting medical orders are intended for patients who are considered to be at risk for a life-threatening clinical event because they have a serious life-limiting medical condition, which may include advanced frailty. For these patients, their current health status indicates the need for standing medical orders. For healthy patients, an advance directive is an appropriate tool for making future end-of-life care wishes known to loved ones.