A POLST, short for Physicians Orders for Life-Sustaining Treatment, is a critical medical document that spells out a patient’s preferences regarding treatments that could sustain life during emergencies. This includes interventions like cardiopulmonary resuscitation (CPR), mechanical ventilation, and artificial nutrition. The POLST form, which is a legally recognized order, must be signed by a physician or a licensed healthcare provider and becomes an integral part of the patient’s medical record.
How is a POLST Different from an Advance Directive?
While both POLST and Advance Directives are aimed at planning for future healthcare decisions, there are notable differences between the two. An Advance Directive is a broader legal document created in advance to outline one’s healthcare wishes if they become incapacitated. A POLST, in contrast, is a set of medical orders designed for people already facing serious illness or frailty, with specific instructions for healthcare providers to follow in urgent medical scenarios. Unlike an Advance Directive, the POLST is immediately actionable and travels with the patient across healthcare settings, ensuring their treatment preferences are respected and executed promptly.
Who Should Have a POLST?
The POLST form is particularly recommended for:
- Individuals with serious illnesses or advanced frailty requiring immediate guidance on lifesaving measures.
- Elderly patients with complex medical needs, to avoid unwanted, aggressive treatments.
- Patients with chronic or advanced diseases, such as cancer or heart failure, conveying precise instructions for emergency care.
- Those with cognitive impairments or conditions like dementia, ensuring their care preferences are understood and respected.
- Anyone looking to avoid aggressive interventions, favoring comfort and palliative care in their final stages of life.
How to Complete a POLST Form
Completing a POLST form is a collaborative process involving the patient, healthcare providers, and often, family members. Here’s a step-by-step approach to ensure your POLST accurately reflects your wishes:
- Collaborate: Have a detailed discussion with your doctor about your current health, potential future medical scenarios, and your values and treatment preferences.
- Document: With your healthcare provider, document your treatment preferences on the POLST form, which includes detailed instructions on CPR, intubation, and artificial nutrition and hydration.
- Sign and Validate: Ensure the form is signed by the healthcare professional, typically a physician or nurse practitioner, to make it legally valid.
- Communicate and Display: Make sure the POLST is visible in your medical records and inform all your healthcare providers, caregivers, and, if applicable, your healthcare proxy or power of attorney about your POLST orders.
- Review and Update: Regularly assess and revise your POLST to account for any changes in your health status or treatment preferences.
Benefits of Having a POLST
The POLST framework provides numerous benefits:
- It clarifies a patient’s treatment preferences, fostering respect for their choices by healthcare professionals.
- It helps avoid unnecessary or undesired medical interventions, reducing stress and trauma for the patient and family.
- The POLST form is accessible in any care setting – crucial for ensuring that in an emergency, medical teams can make informed decisions quickly.
- It fosters clear communication between patients, families, and healthcare teams, leading to better care alignment with patient wishes.
- With a POLST, conflicts among family members and between medical providers regarding the patient’s end-of-life care can be minimized, supporting dignity and unity in the care process.
What is a POLST?
A POLST (Physicians Orders for Life-Sustaining Treatment) is a critical medical form that records a patient’s preferences for life-sustaining medical interventions, such as cardiopulmonary resuscitation (CPR), intubation, and artificial nutrition. Distinct from an advance directive, which outlines general wishes, the POLST contains precise medical orders that healthcare professionals must follow during emergencies.
This document is most beneficial for individuals facing serious illnesses, marked frailty, or those at an advanced age, where immediate medical decisions are often necessary. It ensures that the treatment provided aligns with the patient’s own choices and health care goals.
Creating a POLST requires in-depth communication between the patient and their healthcare provider, with possible inclusion of family members. Together, they discuss and agree upon the patient’s treatment preferences, which are then reflected in the POLST. This document serves as a vital guide for emergency medical personnel and other healthcare providers to deliver care consistent with the patient’s wishes.
How is a POLST Different from an Advance Directive?
A POLST form and an advance directive both serve to communicate a patient’s end-of-life care preferences, but they differ significantly in their application and scope. A POLST is a medical order that is signed by a healthcare professional and specifies a patient’s choices regarding life-sustaining treatments in emergency situations or when a patient is critically ill. It contains actionable orders that healthcare providers must follow, such as preferences for CPR, intubation, and artificially administered nutrition and hydration.
Explanation of Advance Directive
An advance directive, on the other hand, is a legal document created by an individual to outline their medical treatment preferences should they be unable to communicate. It often includes a broad array of healthcare decisions and may appoint a healthcare proxy to make decisions on the individual’s behalf. The flexibility of an advance directive allows individuals to consider a wide range of medical scenarios and specify their choices in detail.
Comparison between POLST and Advance Directive
While both documents are designed to honor a patient’s healthcare preferences, there are key differences:
- Creation: Advance directives are usually completed by individuals, involving their personal reflection or discussions with family members, without the need for a healthcare professional’s signature. In contrast, a POLST form must be filled out and signed by a healthcare provider, incorporating the patient’s current medical condition into the decision-making process.
- Scope: An advance directive is generally broader, covering a vast array of potential medical interventions and care decisions, while a POLST form is focused on immediate life-sustaining treatments.
- Accessibility: A POLST form is designed to be easily accessible to healthcare providers across different settings, meaning its orders are immediately actionable. Advance directives may not be immediately available or known to emergency medical personnel.
- Actionability: The POLST form provides specific and clear medical orders that can be acted upon directly by healthcare providers, whereas advance directives may require interpretation and are used to guide health care proxies or family members in decision-making.
- Recognition: POLST forms are standardized and recognized in various healthcare settings, whereas advance directive formats and terminology can vary by state or country.
Both documents are integral to advance care planning, and their effective combination can offer comprehensive guidance for a patient’s care. While an advance directive may outline overall wishes, including preferences beyond immediate medical treatments, a POLST form translates a patient’s preferences into medical orders tailored to their current medical state for swift implementation during a crisis.
Who Should Have a POLST?
A POLST (Physicians Orders for Life-Sustaining Treatment) is a vital document for specific groups of people who require clear communication regarding their treatment preferences. Understanding POLST is crucial for ensuring that life-sustaining interventions align with a patient’s wishes, particularly during emergency situations when they may not be able to communicate.
Individuals with Serious Illness or Frailty
For individuals suffering from serious illnesses or experiencing a state of frailty, a POLST form is of particular importance. Such individuals may include those with terminal conditions like advanced cancer or progressive heart failure, where the disease trajectory is often unpredictable and the capacity to make informed decisions can fluctuate. A POLST ensures that these patients’ treatment preferences are clearly outlined and can be honored at a moment’s notice.
Owing to the nature of their conditions, patients with serious illnesses or frailty may find themselves unable to make urgent medical choices. A POLST form provides them with a voice, to preemptively express their wishes pertaining to life-sustaining treatments, such as the use of ventilators, resuscitation efforts, or tube feeding.
It is also beneficial for reducing unnecessary medical interventions that may not align with the individual’s goals for their care. With a POLST in place, healthcare providers have direct access to orders that reflect each patient’s personal health care choices, thus aligning the treatments given with the patient’s desired approach to end-of-life care.
A POLST form eliminates much of the stress and uncertainty by ensuring that during a health crisis, medical staff, patients, and their families are all in agreement about the desired course of treatment. This document serves as a bridge of communication between a patient’s previously expressed wishes and the actions of emergency healthcare providers.
Elderly Patients
Elderly patients, in particular those with multiple or complex medical conditions, are another group who stand to benefit significantly from having a POLST. With age, the likelihood of sudden changes in health status increases, making the need for a POLST even more pressing.
Research has indicated that without clear instructions, elderly patients are at risk of receiving aggressive and invasive treatments that may not enhance their quality of life or reflect their true healthcare desires. A POLST form is an effective tool for preventing such scenarios because it documents the elderly patient’s specific wishes regarding life-sustaining interventions.
Due to factors like cognitive decline, communication barriers may be present for some elderly individuals. The POLST form serves as a legally recognized means of clearly conveying treatment preferences when a patient may no longer be able to articulate them. With a POLST, these patients can ensure that their care aligns with their values and desired quality of life, even in urgent or unexpected medical situations.
It is the presence of the POLST form, acknowledged and followed by healthcare providers, that guarantees respect for the articulated preferences of elderly individuals. Thus, POLST forms are instrumental in guiding healthcare teams to administer care that respects patient autonomy and honors their spiritual, emotional, and physical well-being as they navigate the complexities of advanced age and health decline.
How to Complete a POLST Form
Completing a POLST form is a collaborative and thoughtful process that should accurately reflect a patient’s treatment preferences. As these forms serve to direct healthcare professionals in providing the type of care aligned with the patient’s wishes, it is crucial to ensure the document is correctly filled out and valid.
Who Can Complete a POLST Form
A POLST form can be completed by various healthcare professionals in collaboration with the patient or their authorized healthcare proxy. Most commonly, a physician, nurse practitioner, or physician assistant would undertake this process. However, in some states and under certain conditions, other healthcare professionals such as registered nurses or licensed practical nurses may be authorized to complete a POLST with proper training and guidance.
The healthcare professional responsible for filling out the POLST form must be well-informed about the patient’s medical status, prognosis, and the potential benefits and drawbacks of specific life-sustaining treatments to guide the decision-making process effectively.
Steps to Completing a POLST Form
To complete a POLST form, follow these carefully considered steps:
- Patient Consultation: Initiate a detailed conversation with the patient or their authorized decision-maker to understand their goals, values, and specific wishes pertaining to life-sustaining treatments.
- Medical Review: Discuss the patient’s current health condition, the likely progression of any diseases, and the possible outcomes of treatments or interventions. Ensure the patient or proxy understands the information to make informed decisions.
- Documenting Preferences: Record the patient’s choices on the POLST form regarding care options like CPR, intubation, antibiotics, artificial nutrition, and any other pertinent treatment wishes.
- Legal Validation: The POLST must be signed by the healthcare professional and the patient or their healthcare proxy to be legally valid.
- Record Placement: Ensure the completed and signed POLST form is prominently displayed in the patient’s medical records for quick access by healthcare providers.
- Copying and Communicating: Provide a copy of the POLST form to the patient, their family, and all involved healthcare providers. Ensure the patient’s healthcare agent or proxy, if applicable, also receives a copy.
- Regular Review: Arrange for the POLST form to be reviewed periodically, especially when there are significant changes to the patient’s health status or if they wish to change their treatment preferences.
When understood and implemented correctly, the POLST form is a dynamic tool that provides clarity and direction for both the healthcare team and the patient, ensuring that medical care respects and aligns with the patient’s end-of-life wishes.
Benefits of Having a POLST
The Physicians Orders for Life-Sustaining Treatment (POLST) form represents a significant step in medical planning, particularly for individuals with serious illnesses or who are nearing the end of life. The realm of healthcare can often be uncertain, and POLST serves as a crucial tool to assert a patient’s voice when they may not be able to communicate their wishes. One of the key benefits of having a POLST form is that it ensures a patient’s medical preferences are diligently respected and followed. This not only offers peace of mind to patients and their families but also safeguards personal autonomy by making sure their end-of-life wishes are clearly outlined and honored.
Ensures Patient’s Wishes are Honored
Having a POLST form in place is akin to creating a personalized healthcare blueprint. This document empowers patients by meticulously recording their specific desires regarding various life-sustaining treatments, such as the use of CPR, intubation, and artificial nutrition. It stands as an affirmation that these critical choices are made by the patient in a calm and considered manner, rather than in the midst of a medical emergency. The documentation acts as a promise to honor these wishes, thereby preventing unwanted or invasive medical interventions and reducing the emotional and physical distress that may come at the end phase of one’s life. This document plays a vital role in the patient’s care, offering the reassurance that their preferences regarding medical interventions and comfort care will be revered.
Provides Clarity for Healthcare Providers
For healthcare providers, the POLST form is a beacon of clarity that illuminates a patient’s preferences in urgent or emergency situations. This clarity is crucial as it guides the delivery of care that is consistent with the patient’s values and intended outcomes, thereby improving the effectiveness of communication between all involved parties. By detailing the patient’s wishes, healthcare providers across settings—from hospitals to nursing homes, and even in the patient’s own home—are better equipped to make decisions that align with the patient’s goals. The POLST ensures that not only are patient preferences clearly understood but that these orders are actionable and immediately available, thereby reducing the likelihood of unnecessary hospitalizations or interventions that do not align with the patient’s holistic care plan. This understanding promotes a higher quality of care and patient satisfaction, as treatments and care strategies are designed to fulfill the patient’s own directives.