Physician Orders for Life-Sustaining Treatment (POLST)
CLICK HERE TO DOWNLOAD THE POLST FORM
While methods of documenting end-of-life wishes have included advance directives, preferred intensity of care, and living wills, an improved option is now available in California. Physician Orders for Life-Sustaining Treatment (POLST) is a physician order form that complements an advance directive by taking the individual’s wishes regarding life-sustaining treatment and converting them into a medical order. POLST is designed both to be a statewide mechanism for an individual to communicate his or her wishes about a range of life-sustaining or resuscitative measures and a portable, authoritative, and immediately actionable physician order that will be honored across treatment settings.
POLST is particularly useful for persons who are frail and elderly or who have a compromised medical condition, a prognosis of one year of life or less, and/or a terminal illness. It should be executed as part of the healthcare planning process and reflect careful decision making by the person and/or their legally recognized healthcare decision maker, in consultation with their physician, about the patients specific condition. While the POLST form can be explained to the patient or his/her representative by a healthcare provider, such as a licensed nurse or social worker, questions about the efficacy or appropriateness of the treatment options should be deferred to a discussion with his/her physician.
One of the many goals of the POLST form is to increase the number of patients who have informed conversations with their physicians about their end-of-life preferences, which can be written as a physicians order and placed in the patient’s medical record, thereby increasing accessibility to the patient’s goals by medical staff. As identified in the 2004 RAND review of the evidence-based literature published between 1990 and 2007 regarding the effectiveness of interventions is the fact that when using POLST, which is “designed to travel across treatment settings to ensure continuity of care, orders regarding CPR in nursing homes were universally followed and were honored across settings. Residents with a POLST received more comfort care and were rarely transferred to a hospital for life-sustaining treatment.”
San Diego County’s POLST Implementation Project
Lynette Cederquist, MD, co-chair of the San Diego County Medical Society’s Bioethics Commission, has received a two-year grant to head up San Diego County’s POLST Implementation Project. Under this project, several trainers will be educating appropriate professionals within the community, including hospital staffs, senior living facilities, hospices, and EMS professionals on the proper use of the POLST document. If you would like more information, have questions, or would like training at your facility, please contact the project coordinator at SDCMS at (858) 565-8888. The 2009 California POLST form is also available for download free of charge at http://www.FinalChoices.org.