Facing a terminal illness means making important decisions about end-of-life care. A POLST form ensures those choices are respected.

In this article, we’ll explore how POLST forms help patients and why Trustworthy is the ideal solution for securely storing critical medical documents.

Key Takeaways 

• A POLST (Physician Orders for Life-Sustaining Treatment) is a medical order outlining your medical treatment preferences.

• Unlike an advance directive, a POLST form is a medical order that healthcare providers are legally bound to follow.

• A POLST form includes three key medical decisions on cardiopulmonary resuscitation (CPR), medical interventions, and artificially administered nutrition.

What Is a POLST Form?

Patrick McClure, a Health Expert and CEO of WINIT Clinic, explains:

“A POLST is a legally recognized document that ensures the medical professional is following the patient's desires in life-threatening situations.”

The form is used to provide first responders and healthcare providers explicit instructions about treatment that must be followed, 

While similar to other medical orders like an advanced directive or living will, a POLST form is more specific. Key differences between a POLST form and an advanced directive are: 

• POLST forms are medical orders: For this document to be valid, it must be signed by a healthcare provider, whereas an advance directive does not need a doctor’s signature to be valid.

• POLST forms are more common for patients with serious illnesses: While anyone can have a POLST form, people with terminal illnesses will have one to outline their preferences for life-sustaining treatments like CPR and nutrition.

• Advance directives are broader: While advance directives outline preferences for CPR, POLST forms provide specific instructions.

Patients with terminal illnesses who want their wishes honored should consider creating a POLST form. If you or a loved one have created one, store it somewhere accessible but still safe, like Trustworthy. Trustworthy’s Family Operating System® is designed with family needs in mind. Benefits like customizable templates, AI-powered organizational tools, and collaboration features streamline document organization so you can instantly find the information you need.   

McClure adds that “all family members, selected proxies of health, caretakers, and home care workers should know what your POLST document states.”  

The Importance of POLST Forms for Patients with Terminal Illnesses

It’s common for terminally ill patients to feel like they have no control over their bodies, so a POLST form can give them a voice in their medical treatment. Patients will have strong opinions and wishes about the care they want, whether comfort-focused palliative and hospice care or more aggressive curative treatments. The POLST form outlines these decisions. 

Why terminally ill patients benefit from having clear medical orders: 

• Ensures medical orders are followed: Unlike other medical forms, a POLST form is a medical order that ensures all medical professionals respect the patient’s wishes.

• Minimizes unwanted interventions: Some patients may not want invasive life-saving treatments like CPR, as they may not align with their health goals.

• Provides peace of mind: A POLST form helps provide the patient peace of mind that major medical decisions are already made and the burden does not fall upon family members.  

Key Medical Decisions Covered in a POLST Form

The POLST form requires patients to make three key medical decisions: cardiopulmonary resuscitation (CPR), medical interventions, and artificially administered nutrition. 

Choices regarding CPR (Do Not Resuscitate vs. Full Treatment)

Deciding on CPR is crucial since first responders check for a pulse first. Without one, they perform CPR unless instructed otherwise. Keep your POLST form in an easy-to-find spot, like the fridge, for quick access.

For patients suffering from serious or life-threatening conditions, CPR can end up doing more harm than good. Former Senior Director of NCOA’s Center for Healthy Aging, Kathleen Cameron, explains: 

“It’s important to know that CPR is a traumatic procedure. Popular culture doesn’t usually talk about it this way, but CPR often can do more harm than good—especially for certain people who already are near the end of life.” 

Common injuries from CPR include broken ribs, skeletal chest injuries, vomiting, abdominal distension, aspiration pneumonia, and internal brain injuries due to a lack of blood circulation. 

Patients will also need to choose whether they want to receive resuscitation or not by signing a Do Not Resuscitate (DNR). 

Preferences for Medical Treatment  

Your POLST form outlines your treatment preferences:

• Full Treatment: Allows all medical interventions, including ICU care and ventilators. First responders will take you to the hospital.

• Selective Treatment: Provides hospital care and IV treatment but avoids ventilators and breathing tubes.

• Comfort-Focused Care: Prioritizes staying at home with pain management and minimal medical intervention.

Options for Artificial Nutrition, Hydration, and Other Life-Sustaining Treatments

The third key medical decision terminal patients will have to make is whether they wish to receive nutrition via a feeding tube and for how long. 

The four options available are: 

• Provide feeding through new or existing surgically-placed tubes 

• Trial period for artificial nutrition but no surgically-placed tubes 

• No artificial means of nutrition is desired 

• Not discussed or no decisions made 

The reason why some patients may not want to receive feeding tubes is that the tubes sometimes require surgery to place them and can cause complications like reflux, aspiration pneumonia, and skin irritation. 

How POLST Forms Guide Healthcare Providers and Caregivers

POLST forms are incredibly important because doctors and emergency responders use them to make immediate medical decisions regarding treatment. 

A POLST form ensures continuity of care across different medical settings, such as hospitals, hospices, and home care. It is also a legally binding document that healthcare providers must follow. Failure to follow this medical order can be considered medical malpractice, and the medical professional could face legal action. 

Who Should Have a POLST Form?

Anyone can have a POLST form, but it's especially beneficial for those with terminal or chronic illnesses like advanced cancer, heart failure, or dementia. Hospice and palliative care patients often use it to document their end-of-life preferences.

Hospice and palliative care teams, including doctors, spiritual advisors, and social workers, help patients make informed decisions about life-saving treatments and POLST forms.

It's best to create a POLST form after a serious diagnosis. Consult your doctor to discuss concerns, understand the implications, and complete the form when ready.

Differences Between POLST and Advance Directives

While POLST forms and advance directives are medical forms outlining a patient's preferences, the POLST form is more specific. The reason for this is that a POLST form is a medical order, whereas an advance directive is general wishes about treatment, and healthcare providers are not legally bound to follow the document. 

Your POLST form is not a replacement for an advance directive, and using both types of documents is excellent for communicating health care decisions. Your POLST form will complement your advance directive and ensure that healthcare providers carry out your decisions.  

For example, your advance directive will appoint your healthcare proxy to make medical decisions on your behalf, and the POLST form will outline those specific instructions to ease the burden of responsibility on your healthcare proxy. 

The Role of Family and Caregivers in POLST Discussions

Family and caregivers play a vital role in ensuring POLST decisions are understood and followed. Open communication helps prevent conflicts in emergencies.

Caregivers should be informed about the POLST form and its importance in honoring the patient’s wishes. Trustworthy’s AI-powered Autopilot simplifies document management with predefined medical categories, insights, summaries, and smart search for quick access.

Securely share documents by setting up a trusted network for family, caregivers, and advisors. Use SecureLinks™ to create expiring, view-only links, maintaining full control over your records.

State-Specific POLST Rules and Availability

If you plan on traveling or moving states, you must know whether your POLST form is valid. You’ll find that some states will have signature requirements different from those of your home state. 

For example, some states like Alaska and Maine do not require a patient signature, while other states might. You can follow the signature requirements provided by the National POLST organization. 

CEO of WINIT Clinic, Patrick McClure adds:

“State-specific POLST registries also go a long way in ensuring these vital medical orders will be available when needed. In many states, a central, web-based repository allows a health provider or emergency responder access to a patient's POLST form in record time.”

Common Misconceptions About POLST Forms

There are a couple of misconceptions about POLST forms that may prevent patients who need this form from getting one. Some common myths include: 

Myth: A POLST Form Means Stopping All Treatment

POLST forms can outline if a patient does not want treatment, but they can also outline what specific treatments they want. 

Myth 2: Only Elderly Patients Need a POLST

Anyone can have a POLST form regardless of age, but it is recommended that patients with terminal or chronic illnesses have them. 

Myth 3: POLST Forms Are Permanent and Cannot Be Changed

POLST forms need to be updated as medical conditions and preferences evolve. They should also be changed if you switch healthcare providers or move to a different state.

You can use Trustworthy to schedule reminders when it’s time to update your POLST form to always reflect your preferences. 

How to Review and Update a POLST Form

Reviewing and updating your POLST form every six months and after changes in your health status is a good idea. To start the process, you must schedule a consultation with your doctor and have them fill out your new POLST form. 

You need to destroy the old form and make sure your new POLST is reflected on your medical records.  

Final Thoughts on POLST and End-of-Life Care

Using Trustworthy, you and your loved ones can have peace of mind that all medical decisions are made and their wishes are honored. When planning for end-of-life treatment, it is crucial to have open discussions and encourage collaboration among family members, patients, and healthcare providers. 

Try out Trustworthy for free and stay as long as you like. 

Frequently Asked Questions 

Does having a POLST form mean I can’t change my mind about my treatment preferences?

No, your POLST form can be changed and revoked at any time. Just make sure you update these changes with your medical providers, caregivers, and family. 

Can a POLST form help reduce medical costs?

Yes, your POLST form outlines what treatments you want to avoid unnecessary or unwanted treatments. 

Does a POLST form override my healthcare proxy or power of attorney?

If there is a conflict, medical providers and first responders will follow the instructions provided in the POLST form.