What is a POLST?

Have you heard talk about the POLST form? POLST stands for Physician’s Order for Life-Sustaining Treatment. This form relates a physician order for treatment for life-threatening events based on your wishes.

This form was developed by healthcare professionals who noticed that many people get care at the end of life that they do not want. Even when a person has an advanced directive, show that much of the time the person’s stated wishes are not carried out. The POLST form is an attempt to simplify and standardaize end-of-life care instructions.

Here are some questions and answers about making end-of life decisions and using the POLST form.

Q: Does the POLST replace the advance directive (AD)?
No. The POLST does not replace an AD and a person might want to have both. An AD designates a decision-maker should a person become incapable of making his or her own decisions. You can also specify the type of treatment that you wish on an AD; however, those wishes cannot be followed by all health professionals. For example, emergency medical technicians and paramedics (who might respond to an ambulance call) cannot use an AD to justify not starting cardiopulmonary resuscitation (CPR). Yet the American Heart Association reports that the success rate for out-of-hospital CPR ranges from 1% (under usual circumstances) to 30% (under ideal circumstances).

Q: Who can act on the basis of a POLST?
Because the POLST form constitutes a physician order, all health care personnel can honor the wishes specified on a POLST.

Q: What is the process for completing a POLST form?
Either you or any healthcare professional can initiate a discussion about the POLST. Ultimately you need to discuss your wishes with your doctor. Both you and your doctor then sign the document.

Q: What does the POLST form say?
The POLST form answers three questions: do you wish to have CPR; what is your overall goal of care (comfort, limited treatment, or full treatment); and if you are unable to eat if you would consider being fed through a tube.

Q: Where do I get a POLST form?
You can get more information about the POLST at the California Commission for Compassionate Care website. You can order a POLST form at this website. Of particular interest to San Francisco residents, the information booklet is available in Spanish, English, and Chinese. The form it available in these languages plus Russian, Farsi, Korean, and others. You can also ask your doctor or clinic where you go for health care.

Q: What should I do with my POLST form once it is complete?
The POLST form is printed on bright pink paper so that it is easy to spot. You should own the original copy of your POLST form and place it on the wall above your bed or on the refrigerator door. These are the locations that pre-hospital care personnel know to look for it. You can make as many copies as you like and these are legal documents. If you have a serious illness, consider carrying a copy with you and/or giving a copy to a close friend or relative.

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San Francisco Senior Care Examiner, Liz Macera, welcomes your feedback, queries, and story ideas via email. Information in this column is intended for health education purposes only and is not intended as personal medical advice nor does this channel create a professional relationship.

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