POLST 4: Honoring End-of-Life Wishes
The POLST form, its origin and how it works
Max Diamond, M.D., Esen Sainz, J.D., MPH, Kendra Oliver, MBA
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Function
The purpose of the POLST Form is to facilitate communication between health care providers and their patients (or Legally Recognized Decision Maker) regarding their personal end-of-life wishes, and also to translate those wishes into clear medical orders. The POLST Form is written in a format to expedite review during an emergency situation. As such, the form starts with CPR (Box A) and ends with identifying the Legally Recognized Decision Maker (Box D, illustrated here).
Typically, when forms are organized in alphabetical sections like this, it is natural for the reader to begin with section “A.” However, the layout of POLST was designed to follow the importance of decision-making during a crisis, not for the order of ease in conversation to complete the form. Yet, many healthcare providers, by default, may review the POLST Form from A through D, which might make the initiation of meaningful conversations with the patient much more challenging.
How to Start the Conversation: Health care providers should take note that a more natural (and less stressful) discussion of POLST is best accomplished by working up from Box D through A (starting at the bottom of the form and working to the top). This recommendation is based on the expert opinion of the (contributing physician) authors.
(This article is part in a series on the proper use of the POLST Form. View whole article and references.)
