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POLST & Advance Directives

A POLST form is neither an advance directive nor a replacement for advance directives. However, both advance directives and POLST 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 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:

Chart: POLST & Advance Directives

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Health care professionals should ask their patients for a copy of their advance directives prior to completing a POLST form and review to ensure the documents are complementary to avoid confusion.
  1. 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.
  2. POLST Form: This is also called different things in different states (see our map for more information) but, regardless of the term, the POLST 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). POLST forms are appropriate for individuals with a serious illness or frailty near the end-of-life.

How an Advance Directive and POLST Form work together

Does a POLST form replace an advance directive?

No. A POLST form complements the advance directive — it does not replace it.

All adults should have an advance directive but an advance directive does not give medial orders. Instead, it provides an idea of what treatments the patient would like to receive and identifies a surrogate who can help make treatment decisions on behalf of the patient.

A POLST form gives medical orders. A surrogate identified in an advance directive can help complete a POLST form on behalf of a patient.

How is an advance directive different from a POLST form?

 

A POLST 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 FormAdvance Directive
Type of DocumentMedical OrderLegal Document
Who CompletesHealth Care ProfessionalIndividual
Who Needs OneSeriously ill or frail (any age)
view guidance		All competent adults
Appoints a SurrogateNoYes
What is CommunicatedSpecific medical orders for treatment wishes during a medical emergencyGeneral wishes about treatment wishes. May help guide treatment plan after a medical emergency.
Can EMS UseYesNo
Ease in locatingVery 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.
Who should have these documents?

All adults should have an advance directive. 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.

There is no age restriction on who may have a POLST form (except in Colorado, Michigan & South Carolina where the form is not allowed to be used by a minor).

Does a patient need an advance directive to have a POLST form?

No, but it is strongly recommended!  If the patient is capable of a POLST discussion, the patient is also likely capable of appointing a surrogate and should be encouraged to do so. If the patient ever loses decision-making capacity, it is the surrogate the patient named in his/her advance directive who is able to create, modify, or void a POLST form.

Can a patient use a POLST form to designate a legal surrogate?

No. Only an advance directive may be used to appoint a surrogate. However, most POLST forms ask for this information on the second side of the form and this information should also be reviewed and updated whenever the form is reviewed with the patient.