What Are POLST Forms? Definition + Purpose

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Having a POLST form is like having your doctor sitting next to you 24 hours a day in case you have an emergency.

POLST forms are medical order forms that seriously ill or frail people who are near the end of life use to receive the treatment they want. The forms contain actual medical orders that your primary care physician prescribes for you, just as they would in your medical chart at the hospital. 

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The medical orders address what treatment you want to have (or not have) in the case of an emergency related to your particular illness or condition. The forms will notify emergency medical personnel of specific treatment plans that your primary care doctor has ordered for you if you experience an emergency related to your illness.  

What Does POLST Stand For?

POLST stands for “Physician Orders for Life-Sustaining Treatment.” These are exactly what the name says they are — they are your physician’s medical orders on whether you should receive life-sustaining treatment during an emergency episode related to your existing illness or condition. 

What Is the Purpose of POLST Forms?

The purpose of POLST forms is to help seriously ill or frail people who are near the end of life receive or decline life-sustaining treatment during an emergency, such as when emergency medical services might be called to the home.

Medical personnel will perform any and all treatment measures to save the life of the person experiencing the emergency without written orders prescribed in the POLST forms. Once the patient is under the care of a medical team, doctors may rely on the standard advanced directives that so often are in place to determine what treatment the patient prefers or to confer with a designated surrogate.

With POLST, if you have a medical emergency related to an illness or condition that you and your doctor have already anticipated and discussed, the POLST form is a legally recognized way for you to indicate your choices for treatment through your doctor’s orders. 

This means the POLST form intervenes with a predetermined medical decision about your life-sustaining treatment options during a medical emergency. Otherwise, emergency care providers will perform measures to save your life until your doctor is able to issue orders for your treatment in response to your emergency or until your surrogate can make your decision for you.

For example, let’s say you suffer from a life-threatening heart condition. When POLST forms are used, you and your doctor would have discussed your condition and recognized that your condition is likely to lead to a heart episode at some point.

If you discuss that possibility with your doctor and express that you would not want medical personnel to perform life-sustaining measures on you in such an emergency, your doctor can issue a medical order not to provide life-sustaining treatment.

If you happen to have a heart attack or life-threatening heart episode, your portable POLST forms will indicate to the medical personnel who respond to your emergency that your own doctor has ordered that such treatment not be given. 

If you have this heart emergency but do not have a POLST form, emergency medical personnel will perform any measures necessary to save your life and transport you to a hospital. The doctors there will then rely on any advance directive you have (if it covers the emergency you are having) or will attempt to confer with any surrogate you have designated to make life-sustaining treatment decisions for you.  

Are POLST Forms the Same as Advance Directives?

No. POLST forms are not the same as advance directives. POLST forms and advance directives should work together to achieve the same goal. Each one is a specific kind of advanced treatment plan, but they are not the same.

An advance directive is a legal document that simply expresses your general preferences for or against life-sustaining treatment or in which you designate a surrogate to make those decisions for you when you are not able to decide because of incapacity.

A POLST form, however, is literally your doctor’s orders for specific medical treatment in response to the emergency you’re experiencing. 

Here are some other differences between POLST forms and standard advance directives:

  • Your health care professional completes and signs your POLST form.
  • You complete and sign your advance directive.
  • Those with life-threatening illnesses or conditions or advanced frailty need a POLST form.
  • Any healthy, competent adult can have an advance directive.
  • You do not need to appoint a surrogate decision-maker in your POLST form because you and your doctor have already made your decision and your doctor is ordering the treatment you agreed upon. 
  • You may need to appoint a surrogate decision-maker in your advance directive in case of a specific emergency in which you are incapacitated.
  • Your POLST form will include specific medical orders directed to any emergency medical personnel responsible for administering treatment in response to your emergency.
  • An advance directive will express only your general preferences for life-sustaining treatment but will not be responsive to any specific medical emergency that you may be experiencing.
  • Emergency medical personnel are able to follow your doctor’s prescribed orders on your POLST form.
  • Emergency medical personnel may not adhere to your stated preferences in your advance directive during a medical emergency.
  • Your doctor’s orders on your POLST form are easily accessible because you will keep the original form with you and your orders also will be included in your medical file.
  • An advance directive is usually not accessible during an emergency episode unless someone is with you who knows where it is located. Even if it is located, it is of no use to you during the emergency.
  • Because your POLST form is completed and ordered by your medical professional, it is the responsibility of your medical professional to review their medical orders with you and update the form as your condition or opinion about life-sustaining treatment changes.
  • It’s up to you or your surrogate to take affirmative steps to review your advance directive and assess its applicability to your current condition. If changes are warranted, you must take the steps necessary to make them.   

How Do You Fill Out POLST Forms?

As a patient, you do not need to fill out your POLST form. You only need to discuss your POLST treatment plan with your physician. Your physician will complete the form that is most appropriate for your illness or condition and your preferences for treatment. 

Think of it like a doctor’s orders in your medical chart or a doctor’s prescription for medicine. You would not complete your own medical chart or write your own prescription for medication.

Likewise, however, your doctor would not order any treatment in your medical chart or write a prescription for medication that he did not discuss with you and consider your opinion about (or obtain your consent). Your doctor would discuss your treatment plan or your medication with you first. 

Now think of your POLST form as a prescription or order in your medical chart for life-sustaining treatment.

Just as you would not fill out your medical chart or write a prescription for this treatment, likewise, you would not fill out your POLST form. Rather, your physician will discuss with you your plan to receive or decline life-sustaining treatment. Only then will your doctor write orders for treatment that complies with what you discussed and agreed to. 

Having a POLST Form Is Like Having Your Doctor With You During an Emergency 

Many states and medical care professionals are adopting the POLST approach to advance care planning. It focuses on patients who are near the end of life and suffer from advanced or life-threatening illnesses or conditions that pose a high risk of a life-threatening event. This approach is just another way to honor a patient’s preferences about receiving life-sustaining treatment at the end-of-life stage. 

If you think you or a loved one would benefit from having a POLST form, speak to your primary health care provider about this option as another piece of your comprehensive end-of-life plan

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