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POLST: An Important Medical Document for End of Life Care

Rita Dichele - September 12, 2016 09:13 AM

POLST stands for physician order for life sustaining treatment. The purpose of POLST is to improve quality of patient care as well as reduce any unnecessary treatments that go against the patient wishes.  It is a document that serves as a tool for patients and their designated health care proxy.  It essentially tells health care providers what types of heroic measures to take as you near the end of life.

POLST is not a legal document but rather a medical document.  An advanced directive is a legal document.  For example, an advanced directive is a living will or health care proxy designation.  A POLST order can be seen as an extra assurance that the patient will receive the type of care he/she wants nearing the end of life.  It complements the advanced directive.

The difference between the two documents is that the POLST is a summary of medical orders.  For instance, some of the orders include: do not resuscitate (DNR); do not intubate (DNT); do not hospitalize (DNH), etc.  These orders are clearly indicated on the document.  However, the language can be confusing.  For instance, the document will indicate FULL STATUS which means ALL medical precautions will be taken.  It is very important to understand the POLST language and to discuss each life sustaining treatment item with your health care provider. 

One of the benefits of having a POLST document is that it can eliminate unnecessary hospitalizations.  This is important for those individuals residing in a long-term care facility as well as those who might die within one year.  Without a POLST, it is conceivable that an individual could die in a hospital when he/she wanted to die at home.  For instance, last year in Oregon 34% of elderly individuals died in the hospital that did not have a POLST.  On the other hand, 6% died at home who had a POLST document.

It is a document that can be updated at any point in time either by the patient or health care proxy or surrogate health care designee.  It is also recommended that when there is a substantial change in your health condition that you readdress the conditions on the POLST form.  POLST does become part of your medical record and in some states it is scanned into a state registry.  The registry is a data base that provides physicians with access 24/7 to determine what type of life sustaining treatment the patient has requested.  This can avoid unnecessary medical treatments, errors, and costs.  However, the POLST document can be changed at any time.  In fact, it can be entirely be eliminated by marking VOID on the form in large letters.  However, it will become necessary to notify your provider as well as any other entity that has a copy of the POLST. Therefore, it is extremely important to be in contact with your health care provider if this should occur. 

Because today’s health care leans towards person-centered care, it is important for providers to work with the patient regarding what they want.  POLST offers the patient the opportunity to communicate their values, beliefs, and goals with their provider.  It is a shared conversation on end of life decisions.  The focus of the conversation is on personal values rather than medical interventions.

The POLST document can only be completed and signed by a physician, nurse practitioner, or physician assistant.  The patient or the surrogate health care designee, if the patients is not conscious or in sound mine, also signs it.  However, it is important to understand everything on the form prior to signing it.
Furthermore, It is not a federal mandate to have one in place but is a voluntary document that patients can have and is developed by the individual states.  Note, however, not all states have a POLST document.
POLST is typically what it is known as.  Some states have different names but essentially align with the same principles and verbiage of POLST.   Nevertheless, this type of order it is generally referred to as POLST.  Your provider will know what you mean if you should ask about this. 

Below is a list of names some states use.
MOLST: Medical Orders for Life-Sustaining Treatment

MOST: Medical Orders for Scope of Treatment

POST: Physician Orders for Scope of Treatment

LaPOST: Louisiana Physician Order for Scope of Treatment

COLST: Clinician Orders for Life-Sustaining Treatment

IPOST: Iowa Physicians Orders for Scope of Treatment

SMOST: Summary of Physician Orders for Scope of Treatment

TROPP: Transportable Physician Order for Patient Preference

WyoPOST: Wyoming Provider Orders for Life Sustaining Treatment

The POLST documentation, which is typically one sheet with information on both sides, should be assessable to EMTs or paramedics.  For instance, putting it on the refrigerator is a good place; as the first responders will look there first.  Otherwise, you can place it by the door.

POLST is not for everyone.  However, it is available for individuals 18 and older.  It is used for those patients who have serious illnesses or are very frail and may not live more than one year.   For instance, a patient may have multiple chronic conditions and be too frail to recover from them. 

Remember, that this is not a life sentence if you choose to have this type of medical documentation. Patients always receive comfort care and as long as they are able, to continue to eat and drink.  Again, the POLST order can be updated and changed anytime. 

On a personal note, my mother had a MOST form in place when she died.  I remember that it was extremely difficult to sign this form on her behalf.  Even though logically I knew that it wasn’t a death sentence, emotionally I felt it was.  However, having the documentation made sense; as it honored my mom’s final wishes.  Without this form, my mom most likely would have been hospitalized and would never have died at home.  Nevertheless, it can feel like a final act that cannot be reversed.  With that being said, I am glad I signed the form.  Now, I can truthfully say that I understand why I did it.  If necessary, I encourage those persons faced with a dying loved one to consider it as well.

Rita Dichele holds three Master degrees in Counseling Psychology, Health Care Administration, and Human Services.  Ms. Dichele is certified in death & dying and bereavement from the Association for Death Education and Counseling (ADEC).  She is on faculty with A.T. Still University and instructs classes in grief work and long-term care.

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