Experiences with POLST: Opportunities for Improving Advance Care Planning

Excerpt

Physician Orders for Life-Sustaining Treatment (POLST), sometimes also known under other terms, e.g. Medical Orders for Life-Sustaining Treatment (MOLST), began in Oregon in 1991 as the “POLST Paradigm Initiative”, a task force of healthcare professionals and ethicists from the Center for Ethics in Health Care at Oregon Health & Science University (OHSU). The goal was to facilitate patients’ choices regarding end-of-life (EOL) care, in particular life-sustaining medical treatments. The “paradigm” was designed around a process of EOL counseling that would lead to completion of a POLST form. In 2004, OHSU’s Center for Ethics in Health Care assembled a task force of representatives from participating states to facilitate the propagation of the POLST paradigm nationally. The new National POLST Paradigm Task Force (NPPTF) has established standards by which individual states can develop “endorsed” POLST programs. POLST forms are now used in over 40 states. In 19 of these, the NPPTF has endorsed state POLST programs as they have become standard components of advance care planning in their location, have addressed legal and regulatory issues, and have developed strategies for ongoing implementation and quality assurance.1 In California, the state about which Jennings et al.2 report in this issue, POLST was fully implemented only in 2009, but is considered (along with Oregon and West Virginia) to have a ‘mature’ POLST program by the NPPTF based on POLST use by 50% or more of hospitals, nursing homes, and hospices in each region of the state. …